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703 SELVA LAKES CIR POOL24-0009 Application , NOCNOTICE OF COMMENCEMENT State of _______________________________ Tax Folio No. ________________________________ County of _____________________________ To Whom It May Concern: The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of the Florida Statutes, the following information is stated in this NOTICE OF COMMENCEMENT. Legal Description of property being improved: ______________________________________________________________________ ____________________________________________________________________________________________________________ Address of property being improved: _____________________________________________________________________________ General description of improvements: ____________________________________________________________________________ ____________________________________________________________________________________________________________ Owner: ___________________________________________ Address: __________________________________________________ Owner’s interest in site of the improvement: _______________________________________________________________________ Fee Simple Titleholder (if other than owner): _______________________________________________________________________ Name: _______________________________________________________________________________________________ Contractor: __________________________________________________________________________________________________ Address: _____________________________________________________________________________________________ Telephone No.: ________________________ Fax No: _____________________________ Surety (if any) ________________________________________________________________________________________________ Address: ______________________________________________________ Amount of Bond $ _______________________ Telephone No: _________________________ Fax No: _____________________________ Name and address of any person making a loan for the construction of the improvements Name: _______________________________________________________________________________________________ Address: _____________________________________________________________________________________________ Phone No: _____________________________ Fax No: _____________________________ Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other documents may be served: Name: _____________________________________________________________________________________________ Address: _____________________________________________________________________________________________ Telephone No: __________________________ Fax No: _____________________________ In addition to himself, owner designates the following person to receive a copy of the Lienor’s Notice as provided in Section 713.06(2) (b), Florida Statues. (Fill in at Owner’s option) Name: ______________________________________________________________________________________________ Address: ____________________________________________________________________________________________ Telephone No: __________________________ Fax No: _____________________________ Expiration date of Notice of Commencement (the expiration date is one (1) year from the date of recording unless a different date is specified): ___________________________________________________________________________________________________ THIS SPACE FOR RECORDER’S USE ONLY OWNER Signed: ________________________________________ Date: ___________________ Before me this __________ day of __________________ in the County of Duval, State Of Florida, has personally appeared __________________________________________ Notary Public at Large, State of Florida, County of Duval. My commission expires: ____________________________________________________ Personally Known: ______________________________________________________ or Produced Identification: ____________________________________________________ DĂƌĐŚϮϬϮϰ ƵƌŽƌĂWĞƌƌŝĞŶ ϰͬϮϱͬϮϬϮϲ y Florida 172027-5872 Duval 44-60 16-2S-29E SELVA LAKES UNIT 3 LOT 140 703 Selva Lakes Circle, Atlantic Beach FL 32233 In-Ground Swimming Pool Aurora Perrien 703 Selva Lakes Circle, Atlantic Beach, FL 32233 Resident Premier Pools and Spas 3728 Philips Highway #4, Jacksonville, FL 32207 (904) 676-0076 12 Building Permit Application Updated 10/9/18 City of Atlantic Beach Building Department 800 Seminole Road, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: _______________________________________________________ Permit Number: ____________________________ Legal Description ________________________________________________________________ RE# _________________________ Valuation of Work (Replacement Cost) $_________________ Heated/Cooled SF ___________ Non- Heated/Cooled_____________ x Class of Work: □New □Addition □Alteration □Repair □Move □Demo □Pool □Window/Door x Use of existing/proposed structure(s): □Commercial □Residential x If an existing structure, is a fire sprinkler system installed?: □Yes □No x Will tree(s) be removed in association with proposed project? □Yes (must submit separate Tree Removal Permit) □No Describe in detail the type of work to be performed: Florida Product Approval #______________________________________________ for multiple products use product approval form Property Owner Information Name ______________________________________________ Address _________________________________________________ City ____________________________________ State _______ Zip _______________ Phone ________________________________ E-Mail ______________________________________________________________________________________________________ Owner or Agent (If Agent, Power of Attorney or Agency Letter Required) _________________________________________________ Contractor Information Name of Company _______________________________________ Qualifying Agent _______________________________________ Address________________________________________________ City___________________ State ________ Zip_______________ Office Phone ____________________________________ Job Site Contact Number _______________________________________ State Certification/Registration # ____________________ E-Mail_______________________________________________________ Architect Name & Phone # ______________________________________________________________________________________ Engineer’s Name & Phone # _____________________________________________________________________________________ Workers Compensation Insurer _____________________________________ OR Exempt □ Expiration Date ___________________ Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS, and AIR CONDITIONERS, etc. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. OWNER’S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. ___________________________________________________ (Signature of Owner or Agent) Signed and sworn to (or affirmed) before me this ____ day of ___________, ________, by ____________________________ ________________________________ (Signature of Notary) [ ] Personally Known OR [ ] Produced Identification Type of Identification: ______________________________________ ___________________________________________________ (Signature of Contractor) Signed and sworn to (or affirmed) before me this ____ day of ___________, ________, by ____________________________ ________________________________ (Signature of Notary) [ ] Personally Known OR [ ] Produced Identification Type of Identification: ______________________________________ **ALL INFORMATION HIGHLIGHTED IN GRAY IS REQUIRED. 703 Selva Lakes Circle, Atlantic Beach, FL 32233 44-60 16-2S-29E SELVA LAKES UNIT 3 LOT 140 172027-5872 69,120.00 In-Ground Swimming Pool 12'x22' 8393 Gallons 703 Selva Lakes Circle Atlantic Beach FL 32233 504-296-7314 auroreos07@yahoo.com Premier Pools and Spas Jacob Zervakis 3728 Philips Hwy, Suite 4 Jacksonville FL 32207 904-204-3200 904-676-0076 CPC1459957 lstebbins@ppas.com Florida Engineering LLC / 941-391-5980 FCCI Insurance Company 3/21/2024 March 2024 March 2024 Jacob Zervakis Aurora Perrien Aurora Perrien 12 12