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BONITA 715 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 09-00000521 Date 5/26/09 Property Address . . . . . . 715 BONITA RD Application type description RESIDENTIAL ADDITION/ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 10000 ---------------------------------------------------------------------------- Application desc remodel bath and general repairs ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ FLORES, SIMON UNLIMITED DIMENSIONS 715 BONITA ROAD 7 DRUM PLACE ATLANTIC BEACH FL 32233 PONTE VEDRA BCH FL 32082 (904) 838-3774 --------------------- Structure Information 000 000 ---------------------- Construction Type . . . . . TYPE 5-A Occupancy Type . . . . . . RESIDENTIAL Flood Zone . . . . . . . . ZONE X ---------------------------------------------------------------------------- Permit MECHANICAL HVAC PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . valuation . . . . 0 Expiration Date . . 11/22/09 ---------------------------------------------------------------------------- Special Notes and Comments *2007 FLORIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS . 2007 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. WINDOW AND DOOR INSPECTION: *INSTALLATION INSTUCTIONS REQUIRED *ALL STICKERS ARE TO REMAIN ON THE WINDOWS *PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 35 . 00 35 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 35 . 00 35 . 00 . 00 . 00 PERmj,r IS APPROVED ONLY IN ACCORDANCE NVITH ALL CITY OF A'FLiLNTIC BEACII ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC BEACH 09- 800 SEMINOLE ROAD,ATLANTIC BEACH,FIL 32233 OFFICE:(904)247-5826 0 FAX NO.:(904)247-5845 -DEPT@COAB.US BUILDING ELECTRICAL PERMIT APPLICATION DUVAL COUNTY 3'.IDATt- IS�THIS'A SUB PERMIT S, JOB ADDRES 13 NO 91AS PERMIT#:m PROPERTY OWNER"'-,--.,� 4.NAW. 5.ADDRESS IF DIFFERENT FROM JOB ADDRESS: 6.PHONE. P 77 2�6 ELECTRICAL CONTRACTOR:- 7.NAME OMPA 8.ADDRESS.:---7 /V I/ �11$ 9.STATE OF FLORID �Ll ENSE 01 10.CELL PHONE, 11.FAX NO.: ;F �;3 � -71�77_ _ _ 12.EMAIL ADDRESS. 13.OFFICE PHONE.j 14. �001 - L. 6olk 1 -7- 4 10? 15.P pp!cation is ere y mabe-to obtain a permit to do the work and installations as indicated. I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within sb((6) months,or if construction or work is suspended or abandoned for a period of six(6)months a y time after work is commenced. CONTRACTORS SIGNATURE: METER NUMBERw� ,I C CLASS OF WC157.-7.7 FAMILY-#OF UNITS: 0rRESIDENTIAL CPSIN LE FAMILY 0 TEMP SERVICE 0 COMMERCIAL [3 ADDITION 0 TRAILOR m 19�.CURRENTCODE-. •ALTERATION El SIGN DIOLD 13 NEW 0'05 NATIONAL ELECTRICAL CODE •REPAIR OPOOL/SPA 0 REWIRE 0 OTHER: 0 -ELgqTR1qALVyORK,�;, LIST ALL. 20.TYPE OF SERVICE: VOVERHEAD 0 UNDERGROUND 0 UNDERGROUND UP POLE 21.NEW SERVICE: CONDUCTORS PER PHASE: 0 POWER IS ON El POWER IS OFF 22.SIZE OF CONDUCTOR: AMPACITY: DCOPPER 0 ALUMINUM 23.SWITCH OR BREAKER SIZE. AMPS. PH: W:_ VOLT:_ RACEWAY SIZE: 2 24.EXISTING SERVICE SIZE- AMPS: PH: W---11- VOLT:av_ RACEWAYSIZE: 25.FEEDERS: OF_ AMPS: #OF- AMPS:- *OF- AMPS: 2' 2 26.LIGHTING FIXTURES: IINCANDESCENT: FLUORESCENT&M.V.: 27.FIXED APPLIANCES: 0-30 AMPS: 31-100 AMPS: OVER 100 AMPS: 28.FIRE ALARM: DYES 0 NO 29-311 DO NOT APPLY TO NEW SINGLE FAMILY,MULTI-FANLY AND ROOM ADDITIONS 29.SMOKE DETECTORS: NUMBER: 30.RECEPTACLES: 0-30 AMPS: 31-IOOAMPS: OVER 100 AMPS: 31.SWITCHES: 0-30 AMPS: 31-100 AMPS: OVER 100 AMPS: 32.AIR CONDITIONING. #OF UNITS: COMP. MOTOR HP RATING: AMPS: HEAT iW. #OF UNITS: COMP. MOTOR HP RATING: AMPS: HEAT KW: 33.MOTORS:, NUMBER: VOLTAGE: HP: KVA: NUMBER: VOLTAGE: HP: KVA: 34.TRANSFORMERS: UNDER 60OV: NUMBER: KVA: OVER 60OV-. NUMBER:- KVA: 35.MISCELANEOUS REPAIRS: rEDESCRIBE IN DETAIL: AtiW Atog BLDG02 Permit Application Flac:REVISED:121118/2003 P7 CITY OF ATLANTIC BEACH 09- 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 OFFICE:(904)247-5826 0 PAX NO.:(904)247-5845 BUILDING-DEPTOCDAB.US PLUMBING PERMIT APPLICATION DUVAL COUNTY 1 JOB ADDRESS: 12.IS THIS A SUB PERMIT, 3.DATE, I I ar 10S PERMIT#: f 71,4 PROPERTY OWNER: 4.NAME: 5 ADDRESS IF DIFFERENT FROM JOB ADDRESS: 8.PHONE: PLUMBING CONTRACTOR. 7.NAME OF COMPANY." 8.ADDRESS.: — -516-q" 'r,d), 6:�>' -7 T o d-&f 9.STATE 9F FLARIDA LICENSE NO: 10.CELL PAONE: 11.FAX NO, xlep'_ 6.lz,?- *1 ,��<- 4 )PC/ 72 12.EMAIL A RESS: 13 OFFICE PHONE 14. Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6) months,or if construction or work is suspended or abandoned for a period of six(6)months at any time after work is commenced. CONTRACTORS SIGNATURE: 15.NATURE OF WORK: 6. 17. 18.CURRENT CODE: IgNEW 0'06 FLORIDA BUILDING CODE- 13 RE-PIPE PLUMBING 0 OTHER7 19.NUMBER OF FIXTURES: BATH TUB SEWER CONNECTION BIDET SHOWERS DISH WASHER SHOWERSPANS, DISPOSAL SINK DRINKING FOUNTAIN WATER CLOSET TANK FLOOR DRAIN WATER CLOSET VALVE HOSE BIB WASHING MACHINES ICE MAKER WATER CONNECTION INTERCEPTOR WATER HEATER LAVATORY URINALS LAUNDRY TRAY OTHER(SPECIFY): ROOF DRAIN 20.PLUMBING PERMrr FEES- PERMIT ISSUING FEE: $35.00 TOTAL FIXTURES: X $7.00 (PER FIXTURE) + $35.00 BLDG03 Permit Applicatrion Plumb:12/18Q008 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 7-5826 INSPECTION PHONE LINE 24 Application Number . . . . . 09-00000521 Date 4/28/09 Property Address . . . . . . 715 BONITA RD Application type description RESIDENTIAL ADDITION/ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 10000 ---------------------------------------------------------------------------- Application desc remodel bath and general repairs ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ FLORES, SIMON UNLIMITED DIMENSIONS 715 BONITA ROAD 7 DRUM PLACE ATLANTIC BEACH FL 32233 PONTE VEDRA BCH FL 32082 (904) 838-3774 --------------------- Structure Information 000 000 ---------------------- Construction Type . . . . . TYPE 5-A Occupancy Type . . . . . . RESIDENTIAL Flood Zone . . . . . . . . ZONE X ---------------------------------------------------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . . Permit Fee . . . . 119 . 00 Plan Check Fee Issue Date . . . . Valuation . . . . 0 Expiration Date . . 10/25/09 ---------------------------------------------------------------------------- Special Notes and Comments *2007 FLORIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS . 2007 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. WINDOW AND DOOR INSPECTION: *INSTALLATION INSTUCTIONS REQUIRED *ALL STICKERS ARE To REMAIN ON THE WINDOWS *PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 119 . 00 119 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 119 . 00 119 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING OFFICIAL 4v X APO", FOR OFFICE USE ONLY ..........19/.7 CITY OF ATLANTIC BEACH Permit -------------Fee$��.............. Valuation FLORIDA House 2X"M&---------- .............PITI-OATIA A APPLICATION FOR BUILDING PERMIT BUILD" 0 FICE .......................... D I W.-�v7/772............... ...................... cificafions-le-r-e-w-itYs'ubffi!tfM for Application is hereby made for the -approval of the detailed statement of the plans and spe 0 building or other structure described. This application is made in compliance and conformity with the Building Ordinance of the City of Atlantic Beach, Florida, and all provisions of the Laws of the State of Florida, all ordinances of the City of Atlantic Beach and all rules and regulations of the Building Department of the City of Atlantic Beach, shall be complied with, whether herein specified or not. The Contractor or Owner-Builder who has been issued a Building Permit is automatically responsible to ascertain that all sub- contractors engaged by him are duly licensed in the City of Atlantic Beach,Florida. To prevent delay or embarrasment regard- ing intermediate or final inspections it is suggested that a list of sub-contractors be submitted to this office so that licenses can be verified. OC Date............././/...... Owner -----------C._o_k.rm,AW------ ------------...Address---2A-�F---0A,1/.rfl-------A-d_-------Telephone No..2-Y-611Y.K.. Architect..................... .1-----.........__........-------------------------------------------Address..........................................................Telephone No............................. Contractor uilder........../f - - -----_------------Address..-----------R.6_�.............................Telephone NO._.-_---------_--- Block No._ .. ....... ---Sub Division.. . .. .... --- 14-5-1---------------Zone,0 Lot N ------------ - ------------- ............ ......... ---_-------------�StreetA04;r4-/?VSide BetweenZ7, --_---------------and........................................... Sts. 0"00 Valuation IF--- --------------------------For what purpose will building be used.... ........Type of construction---�U_0_6 ....... Dimensions of Building------ ----Dimensions of Lot-_.&-------------------------------------------Size of Footings-------------------------------------- t 1_4---7------- Atlo Size of Piers.... ------------_----------Size of Sills...._7 GTeatest Sill Span in ft------_-----------------Type'Roof-------------............. How will Building be Heated?---------Ives ---------------------------------------------Will Building be on Solid or Filled Ground?--------- ........................ Size of Ceiling Joists-..__y.X1....---------- Distance on Centers............................................ Greatest Span............................................ to Size of Floor Joists.--_---------------------------------- Distance on Centers...... ....... ................, Greatest Span............................................ Size of Rafters,..-------------.........--------_----------......Distance on Centers.., ....... ......... ....... Greatest Span-..-........................................ &L This rectangle is to represent the lot r) Locate the building or buildings in the ,-5)77t - -/- -yv��c ea right position. Give distance in feet from all lot-lines and existing buildings. REAR LOT LINE Two copies of plans and specifications shall be submitted with application. Inspections required. 1. When steel is in place and ready to pour footing. 2. When steel in in place and ready to pour columns and/or lintel. Z 3. When steel is in place and ready to pour beam. 4. When framing is completed. 5. When rough plumbing is completed,and ready to cover up. 6. When septic tank drain field or sewer is laid but before it is covered. 7. Electrical inspection by City of Jacksonville. 8. Final Inspection. Note: In case of any rejection,re-nispection MUST be called for eftr corrections are made. FRONT OF LOT In consideration of permit given for doing the work as described in the above statement, we hereby agree to perform said work in accordance with the attached plans and specifications, which are a part hereof, and in accordance with the building regulations of the City of Atlantic Beach. Signature of Builder.............................................................................. Address............................... ......... Signatureof Owner.............................-----_--_---_ --_--_-----_----_--- Address............................... .................................... Ar� 00 A -40 as fp's ZIA ;!%ol! wo --o 49 24 0'& .9 kip 0 *"' N$'O'W t,V ej;s"le N5vv 1�0�px s, 0 # �l d1k Noll, dIt law C10. lv\*�101, o�doo 06 6o� X0 Ito FOR OFFICE USE ONLY Date----------- ........192.3 47-a_!�........ CITY OF ATLANTIC BEACH Permit *.�2.2_36......Fee Valuation $...Z4�............................. FLORIDA House *......70--�5...... ............................................................................ APPLICATION FOR BUILDING PERMIT ...................... Application is hereby made for the-approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure described. This application is made in compliance and conformity with the Building Ordinance of the City of Atlantic Beach, Florida, and all provisions of the Laws of the State of Florida, all ordinancesof the City of Atlantic Beach and all rules and regulations of the Building Department of the City of Atlantic Beach, shall be complied with, whether herein specified or not. The Contractor or Owner-Builder who has been issued a Buildinir Permit is automatically responsible to ascertain that all sub- contractors engaged by him are duly licensed in the City of Atlantic Beach,Florida. To prevent delay or embarrasment regard- ing intermediate or final inspections it is suggested that a list of sub-contractors be submitted/to s office o that licenses can be verified. Date......................... ........... . ..... 19............ Ae,�.dl. ........a1W,4W.1V ... ........ dr .......................................................---Telephone No............................. Owne ....... ,,.,41 _Ad ess. Architect....................... ........ .........;Z,... .......*................Address--------�ng...................................Telephone No-----_---------------------- Contractor Buildi .... ......Address.../4 1------ ........71 ............Telephone N7 LotNo.................. ------- ......Block No................ ...........Sub Division.......r-------I'll-----------1-1-11------------------I-------11---------------Zone............. ......... ............Side Between. and......................................................Sts. Valuation ----------For what purpose will building be used../1(:k.5...................Type of construction---- Dimensions of Building......Ai 4--li------------Dimensions of Lot........................................................Size of Footings...................................... Size of Piers-----------------------------------Size of Sills-------------------------------GTeatest Sill Span in ft._-----------------------Type Roof.., .. ........&Ap" How will Building be Heated?---- ------...............................................Will Building be on Solid or Filled Ground?........................................ Size of Ceiling Joists_4�0_r',V................. Distance on Centers............/6---------------------I Greatest Span.......41-7......................... 7 Size of Floor Joists- & .,L ----------------Distance #n Centers...... ......................... Greatest Span............................................ .. Size of Rafters..................-----------_-------------------- Distance jpn Centers ----------.................. Greatest Span............................................ 11 This rectangle is to represent the lot. Locate the building or buildings in the right position. Give distance In feet from all lot-lines and existing buildings. REAR LOT LINE Two copies of plans ane specifications shall be submitted with application. Inspections required. 1. When steel is in place and ready to pour footing. '7* 09 2. When steel is in place and ready to pour columns and/or lintel. Z Z 3. When steel is in place and ready to pour beam. 4. When framing is completed. 5. When rough plumbing is completed,and ready to cover up. 6. When septic tank drain field or sewer is laid but before it is covered. 7. Electrical inspection by City of:acksonville. W ril 8. Final Inspection. Note: In ease of any rejection,re-inspection MUST be called for after corrections are made. FRONT OF LOT In consideration of permit given for doing the work as described in the above statement, we hereby agree to perform said woA In accordance with the attached plans and specifications, which are a part hereof, and in accortlance with the bull&zr regulations of the City ofA tic ................................................. Signature of Builder,. ... ...... ........ Address../�NW Signature of Owner.... .......... Address........ .................................. 17. Other Category/Subcategory Manufacturer Product Description Limitation of Use State# Local E. SHUTTERS 1. Accordion 2.Bahama 3. Storm panels 4. Colonial 5.Roll-up 6.Equipment 7. Other F. STRUCTURAL COMPONENTS 1. Wood connector/anchor 2. Truss plates 3.Engineered lumber 4. Railing 5. Coolers-freezers 6. Concrete admixtures 7.Material 8. Insulation forms 9.Plastics 10.Deck-roof 11. Wall 12. Sheds 13. Other G. SKYLIGHTS 1. Skylight Category/Subcategory Manufacturer Product Description Limitation of Use state # Local C. PANEL WALL 1. Siding 171 QI�4 AU 2. Soffits 3.EIFS 4. Storefronts 5. Curtain walls 6.Wall louvers 7. Glass block 8.Membrane 9. Greenhouse 10. Synthetic stucco 11. Oth A ROOFE*4G PRODUCTS 1.Asphalt shingles 2.Underlayments 3. Roofing fasteners 4.Nonstructural.metal roof 5.Built-up roofing 6.Modified bitumen 7. Single ply roofing 8.Roofing tiles 9.Roofing insulation 10. Waterproofing 11. Wood shingles/shakes 12. Roofing slate 13. Liquid applied roofing 14. Cement-adhesive coats 15.Roof tile adhesive 16. Spray applied polyurethane roof PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FL. ProjectName: :5YAIA-IV Permit Project Address: -7 1 4-A- j�D A f2:> PJ ;Z 3; :3 e3 vi ( — 3 As required by Florida Statute 553.842 and Florida Administrative Code 9B-72,please provide the information and product approval number(s) for the building components listed below as applicable to the building construction project for the permit:number listed above. You should contact your product supplier if you do not know the product approval number for any of the applicable listed roducts. Information regarding st ewide product app I may be obtained at: www.floridabuilding.org. Category/Subcategory Manufacturer Product Description Limitation of Use State# Local# A.EXTERIOR DOORS 1. Swinging 2. Sliding 3. Sectional 4.Roll up 5.Automatic 6. Other B. WEVDOWS 1. Single hung 6 r-5,;Z-3 ob F1 i;kotAg 2.Horizontal slider 3.Casement 4.Double hung 5.Fixed 6.Awning 7.Pass-through 8.Projected 9.Mullion 10. Wind breaker 11.Dual action 12. Other NOTICE OF COMMENCEMENT Swe of r_>r Tax Folio No. colanty of V T,a W hom,11, May Coacem: -foe undersigned hereby informs you that improvements will be made to certain real property,and in accoi7dauce with Section 713 of the Florida Statutes,the following information is stated Li this NOTICE OF COM-YiENT E _�_ 1"E�_ _ RA -ty being Legal DDescripdon of prope. z improvel Les 9 3 6 P�.-ee� (a6 4- L6 A -215-- 13 V1�'-t Addi-ess o'gropemy be-ing b-npro-;ed: -::g,- General description of improvements: A-j r- Owner: 7 f a v Z4--s- LL-0— Address., lq'7�- Owner's interest in sitte of the impro-kement. L->kit e-x- Fee Sinaple Titleholder(if other than owner): Name: ntractol U. Address: Telephone-N-o.. LQ ,)z3 Fax No: ;7,7 >7 7 V 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: Came of person-within the State of Florida, other than himself, designated by oi upon-whom notices or other documents may be served. Name: Address- Telephone No- Fax No. In addition to hi imself, owner designates the followiIag 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: Lj 4 L-, %-A,11 Address. Telephone Nio: -32 7!/ Fax(No. a-7.3 Expiration dete of N oc of Commenwement(the expirrabion date is one(1)year from the date of recording unless a different date is specified): THIS SPACK FOR RECORDER'S USE ONLY OWNER S: 1�&Wu Date. I ly� A q 1.� /(-)ri -MefE Doc#2009088272,OR SK 14842 Page 2425, Befox-C ml:�-this lay of in the County of DLvad,St tate Number Pagesi I f 90.6da.has personafly appeaxed Recorded 04),15/2009 at 10:42 AM, ;i III I I I Ili --- -- I:iIi1!I:11C,I, III -- of Duval. JIM FULLER CLERK CIRCUIT COURT DUVAL Vgvt COUNTY RECORDING$10-&D y vorida- reo 14,2 lot 1 0 I...III, Bond B ati CITY OF ATLANTIC BEACH 09- 6 8000 EMINOLE ROAD,ATLANTIC BEACH,FL 32233 OFFICE:(904)247-5826 0 FAX NO.:(904)247-5845 -DEPT@COAB.US BUILDING BUILDING PERMIT APPLICATION DUVAL COUNTY JOB ADDRESS.,`�� 3�SO,FT.UNDER Ro3F7777777 7 5- 6.us 4�LEGAL DESCRIPTION:,'.:�. &CLASS OF WORK, OF 6TRUOTURE:�, 0 NEW BUILDING 0 DEMOLITION VrRE�IDENTIT LOT BLOCK SUB DIVISION Dy 0 ADDITION I]CONVERTING USE Q COMMERCIAL DESCRIPTION QFWORK;�,', VALTEPATION 11 ACCESSORY BLDG. 8.FIRE SPRINKUER� UIREPAIR OPOOL/SPA El YES Q-WA Q MOVE 0 OTHER ARCMTECI�ENGINIEER. CONTMCTOR PROPERTY QVMER:,��,-��, 9.NAME: 15.COMPANY NAME 23.COMPANY NAME: 0"s L:,I-M ',VWZT-�14�17AC Ct t7l.,rn fy�y 16.NAME: 24.LICENSEE NAME: C."r-6 -r*_e_. Y Le-..e 10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.: w-7 237 6 me i, Ave- e-6 .5 5�-?<,3 11 4"# 3 1,-,;-L-7 4e 18.ADDRESS: 26.ADDRESS: '7 0 r-,a-wL P J I&311 cY Ptr_$s Lak4,*.,s D A� iz' Rs kk_J-L-A---60-kq 3.2c,-a zz -7j';)c F:1 11.OFFICE PHONE: 12.FAX NO.:66q i 1161 19.OFFICE PHONE: 120.FAX NO.: 27,OFFICE PHONE: B.FAX NO.: I� I ajftgt:�� ?a-V3315377Y k7f-45V T 13.CELL PHONE 21,CELL PHONE: 29.CELL PHONE: Te-LI 9,?!R 97, 7�( Pq-1?yL1 14.EMAIL ADDRESS: 22.EMAIL AQDRYS: 30.EMAIL ADDRESS: :UnC1n+0CQ.'n(Gt- MORT AGEILENDER:� BONDING COMPANY� 'OF OTHERTHAN OVMER)�� 31.NAME 33.NAME: 35.NA E 1-�/ 4- OA: 32.ADDRESS: 34.ADDRESS: 36.ADDRESS: Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has ZAN" commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6)months, or if construcuon or work is suspended or abandoned for a period of six(6) months at any time after work is commenced. I understand that separate permits must be secured forl Electrical Work,Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etc. OWNEWS 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.I will not occupy or use the referenced building or any part therof,until all inspections are finaled anc t, prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMEN TRACTOR'L OWNER cor AGENT";`.. CON jeh' Po 'war of Alto Agen6y'Letter Required) (A may or (Qualifier C n y Sioned: -Date: Signed: Data. Beforemethis dayof 410ri 1- 2009 in the county of Before me this�dy of 2009 in the cou 0 F_; I I Duval is of Florida,qas personally appeared Duval,State of Florida,has perscpally appeared AikZ �AJA A herin by flimself JhrsJtf andaffirms that all statements and declarations are herin by hims;lf h .1d affirmi that all statements and declaratio a true and accurate. true and accurate. Notary Public at Large,State of County of Notary Public at Large,State of FL _County of �0 P onally Known 0 Personally Known rl-luced Identifirato V-10 7,6 F 7 6,-r-ducedIdentificalion krllb. SYU11,361? I IN tary Signal:L;Z: �/ _(-L lNotary Signature: ( () '-A - I ( ) A 0 �late o; ni0gion&pires r, Z4 Cof Y. S IRLEY I GRAHAM b 14 10 /* otary Puhlir�State of Florida F F', Comm'sSiOn#DD' 165 11 5 33 Ponded 8� N ommfssion ExPlres Feb 14 2010 �ssn SLIDG01 Permit Applica on g: Commission#DD 51853' 3 Bonded By National Notary Assn CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 11........ INSPECTION PHONE LINE 247-5826 Page 2 Application Number 09-00000521 Date 4/21/09 Grand Total 129 . 60 129 . 60 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 09-00000521 Date 4/21/09 Property Address . . . . . . 715 BONITA RD Application type description RESIDENTIAL ADDITION/ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 10000 ---------------------------------------------------------------------------- Application desc remodel bath and general repairs ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ FLORES, SIMON UNLIMITED DIMENSIONS 715 BONITA ROAD 7 DRUM PLACE ATLANTIC BEACH FL 32233 PONTE VEDRA BCH FL 32082 (904) 838-3774 --------------------- Structure Information 000 000 ---------------------- Construction Type . . . . . TYPE 5-A Occupancy Type . . . . . . RESIDENTIAL Flood Zone . . . . . . . . ZONE X ---------------------------------------------------------------------------- Permit . . . . . . BUILDING PERMIT Additional desc . . Permit Fee . . . . 80 . 00 Plan Check Fee 40 . 00 Issue Date . . . . Valuation . . . . 10000 Expiration Date . . 10/18/09 ---------------------------------------------------------------------------- Special Notes and Comments *2007 FLORIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS . 2007 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. WINDOW AND DOOR INSPECTION: *INSTALLATION INSTUCTIONS REQUIRED *ALL STICKERS ARE TO REMAIN ON THE WINDOWS *PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS ---------------------------------------------------------------------------- Other Fees . . . . . . . . . CITY RADON SURCHARGE . 24 ST CONSTRUCTION SURCHARGE 4 . 32 AB CONSTRUCTION SURCHARGE .48 STATE RADON SURCHARGE 4 . 56 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 80 . 00 80 . 00 . 00 . 00 Plan Check Total 40 . 00 40 . 00 . 00 . 00 PERMIT IS%6UE9T)RLYT&tA4ORDANCE WITHPA&OCITY OF ATLA§T&%EACH ORDINANCPSPAND THE FLORIDQ0 BUILDING CODES. ,2 % k - . CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 09-00000521 Date 5/13/09 Property Address . . . . . . 715 BONITA RD Application type description RESIDENTIAL ADDITION/ALTERATION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 10000 ---------------------------------------------------------------------------- Application desc remodel bath and general repairs ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ FLORES, SIMON UNLIMITED DIMENSIONS 715 BONITA ROAD 7 DRUM PLACE ATLANTIC BEACH FL 32233 PONTE VEDRA BCH FL 32082 (904) 838-3774 --------------------- Structure Information 000 000 ---------------------- Construction Type . . . . . TYPE 5-A Occupancy Type . . . . . . RESIDENTIAL Flood Zone . . . . . . . . ZONE X ---------------------------------------------------------------------------- Permit . . . . . . ELECTRICAL PERMIT Additional desc REMODEL ADD BATH/ADD LAUNDRY Sub Contractor MCKINNEY ELECTRIC COMPANY Permit Fee . . . . 70 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 11/09/09 ---------------------------------------------------------------------------- Special Notes and Comments *2007 FLORIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS. 2007 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. WINDOW AND DOOR INSPECTION: *INSTALLATION INSTUCTIONS REQUIRED *ALL STICKERS ARE TO REMAIN ON THE WINDOWS *PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 70 . 00 70 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 70 . 00 70 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC BEACH 09- 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 OFFICE:(904)247-5826 0 FAX NO.:(904)247-5845 BUILDING-DEPTGCOAB.US MECHANICAL PERMIT APPLICATION DUVAL COUNTY 1. ADDRESS: 2.13 TM3 A SUB PERMI[T' 3.DATE. IZI NO 0?ao 6`4S PER MIT M. PROPERTY OWNER: 4.NAME: 5.ADDRESS IFBIFFERENT FROM JOB ADDRESS: 6.PHONE: MECHANICAL CONTRACMR. 7.NAME OF CO�PA B.7RESS.:3 01<r/ . --� K )&� /I/,- . V Cp�- 3 Z 9.STATE OF FLDI�IDA LICENSE NO' 10.CE P7�F' 11.FAX NO* Ac yl/ 12.EMAILADDRESS' 13.OFFI PHO 14. -7 N L'759,-� Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six(6) months,or if construction or work is suspended or abandoned for a period of six(6)months at any time after work is commenced. ARI# CONTRACTORS SIGNATURE'- 11.CLASS OF WORK: 16.BUILDING* 17.SERWCE; 1S.CURRENTCODE: 0 NEW INSTALLATION 0 NEW 5FE-SIDENTIAL 0'07 FLORIDA BUILDING CODE- 0 REPLAIC.�T OF EXISTING SYSTEM D�ISTING [3 COMMERCIAL MECHANICAL ,_�r�AALEWLOW ADDITION TO EXIST SYSTEM 0 REPAIR acia"WAL 135FRIENT To i3E iiFr-ALLEB: DOTHER 19.HEAT: 0 SPACE 13 RECESSED OCENTRAL 13 FLOOR BURNERS: - TE 20.AIR CONDITIONING: 0 ROOM 2 NTRAL 21.DUCT SYSTEM: MATERIAL: THICKNESS: MAX CAPACITY: Cf1TI 2 22.REFRIGERATION: MAX CAPACITY: Cfm 23.COOLING TOWER: CAPACITY: 9PIT11 2 2 4.FIRE SPRINKLER: NUMBER OF HEADS: 2 2 5.LIFT SYSTEM- ELEVATOR: MANLIFT: ESCALATOR: AUTOLIFT: NUMBER: 26.COMMERCIAL HOOD 27.FIREPLACE: PREFABRICATED: MASONRY: 28.IRRIGATION: C3 PUMP E3 WELL E3 PIPING 29.GAS PIPING: #OF OUTLETS: 0 GAS AHU: 0 GAS WATER HEATER: 30.OTHER-SPECIFY: SOLAR HEATING, BOILERS,UNIFIRED PRESSURE VESSEL,HEAT EXCHANGER OR COIL IN DUCTS ETC. VALUE FOR OTHER ITEMS: 31.C5509-EQUDVAENT. NUMBER A(g CgNDjTIQNWG,RE IGERATIC N EQUIPMENT,CONDENSORS,ETC. APPRO\ANG OF UNITS DESCRIPTION MODEL# MANUFACTURER TONS AGENCY AIR 32.HEATING EaulPilliIENT.- -NUMBER FMR ES. . 0 LACES.AIR IDLERS ETC. APPROVING --OF UNITS DESCRIPTION MODEL# MANUFACTURER BTU AGENCY I - TYPE LIQUID 33. INKS: APPROVING NUMBER GALLONS CONTAINED MANUFACTURER SERIAL# AGENCY BLDG-34 PermttApp"on Mectr REVISED�12/1t02C08 SENDER:' Comp*e items 4.snd/or 2 for addition 6rvices. I also wish to receive the Complete iten��,and 4a&b. following services (for an extra Print-your figine and address on the reverse of this form so that we can fee): return this card to"u. -Attach,this form1ft the front of the mailpiece,or on the back if space 1. "dressee's Address does not permit. • Write"Return Receipt Requested"on the mailpiece below the articlen 2- 1:1 Restricted Delivery • The Return Receipt Fee will provide you the signature of the person=H=r� C 'o, to and the date of delivery. nsult postmaster for fee. 3. Article Addressed t& 4a. Article Number /7/ 4b. Service Type El Insured F1 Registered 5�1;-ertified E) COD 0 Express Mail Ej Return Receipt%r Merchandise 7. Date of Delivery - gnature(Addressee) 8. Addressee's Address(Offly-If requested and fee is paid) 6. Signature(Agent) PS Form 3811, November 1990 u.s.Gpo:1991—2s7-m DOMESTIC RETURN RECEIPT CITY OF Ve4d - 9&uda 800 SEMINOLE ROAD ATLANTIC BEACH,FLORIDA 32233-5445 TELEPHONE(904) 247-5800 FAX(904)247-5805 December 17, 1992 Simon G. Flores 715 Bonita Road Atlantic Beach, FL 32233 Dear Mr. Flores: our records indicate that you are the owner of the following described property in the City of Atlantic Beach : a7k/a Lot 15, Block 2, R/P Royal Palsm Unit *1 RE#171139-0000 I Investigation of this property discloses and I have found and determined that this property is in violation of the following City of Atlantic Beach Ordinances and Southern Building Code Sections, copies of which are enclosed: 1. Chapter 12-1-2 2. Chapter 12-1-3 3. Chapter 16-3- (a) 4. Chapter 16-3- (b) You are hereby notified that unless the conditions described above are remedied within thirty (30) days from the date hereof, this case will be turned over to the Code Enforcement Board. Under Florida Statute 162. 09, the Code Enforcement Board may impose fines of up to $250. 00 per day for a first violation and $500. 00 per day for a repeat violation. Please contact this office at 247-5826 regarding your intent to bring the subject property into compliance. Sincerely, -ec'e- ka' r� W. Grunewald Code Enforcement Officer KWG/pah cc: City Manager Enclosures CERTIFIED MAIL RETURN RECEIPT REQUESTED SENDER: Complete items I and 2 when additional services are desired, and complete items 3 and 4. Put your address in the"RETURN TO"Space on the reverse side. Failure to do this will prevent this card fro being returned to you.The return r ce�lee i'd n a o��he arson delivered to and —itional teesTFi _ will rov 2q,-ttt., m postmaster tor tees P F-_ 2 m t 0 w —N' - I t the date of delivery, For add a ing sew ces.a v Pa e. on F andAheck box(es)tor additional service(s)requested. I. QF-Show-Ao whom delivered, date, and addressee's address. 2. 11 Restricted Delivery ,,ffxra charge) (Extra charge) 3. ArticleAddressed t -'" ' w 4. Article Number P .613 /71 8c)3 Type of Service: '715 BoN i t-4—RvA i> El Registered 0 Insured rt fi El COD if ied FL- Expriess Mail E] Return Receip for Merchandise Always obtain signature of addressee or agqqt and DATE DELIVERED. 5. Sioatwe — Addr ssee 8. Addressee's Address (ONLY if x requested and fee paid) Wvur Agent onV TZ 3 Date of D ery 2- 9 T- P 101 IlApr. 1989 *U.S.G.P.O.1989-238-815 DOMESTIC RETURN RECEIPT Alf CITY OF 800 SEMINOLE ROAD A1TAN'n(' FLORIDA 32233-5445 TELEPHONE(904) 247-5800 FAX (904)247-5805 August 20, 1992 Mr. Simon G. Flores 715 Bonita Road Atlantic Beach, FL 32233 Dear Mr. Flores: Our records indicate that you are the owner of the following described property in the City of Atlantic Beach: a/k/a Lot 15, Block 2 Royal Palms Unit I RE*171139-0000-1 Investigation of this property discloses and I have found and determined that this property is in violation of the following City of Atlantic Beach Ordinances and/or Southern Building Code Sections; Chapter 12-1-3 Weeds and Trash Chapter 12-1-7 You are hereby notified that unless the conditions described above are remedied within fifteen ( 15) days from the date hereof, this case will be turned over to the Code Enforcement Board. Under Florida Statute 162. 09, the Code Enforcement Board may impose fineB of up to $250. 00 per day for a first violation and $500. 00 per day for a repeat violatiun. Please contact this office at 247-5826 regarding your intent to bring the subject property into compliance. Sincerely., -ew "KarZ r�ri ald Code Enforcement Officer KG/pah cc: City Manager TI;4 t.e A DKPA'\"1',1"'F,NT OF BUILDING City of Atlantic Beach , Florida Application for Permit for Permit No . Bf'(�'�</ E Office- Miscellaneous Alterations Use and Repairs M P Only Contractor C, U) Address Phone Owner tj _(��_—A d d r e s s ---Phone ��itnn The undersigned hereby applies for a permit to C, t- IV Buildin on ______part of Lot No .------Block----Subd.----- At--- side of-------- between---------and -----.---Streets . Valuation Present use for building-- J, If residential , what type Gwelling Qsingle--&m duplex. . ) How many families accomodated now? I 1,Then altered? If business , what type? Will food be prepared for sale on premises?— What plumb ing/mechanical work to be done? Size of present building Size of extension Size of lot Number of stories now When altered Material of existing building_____ Extension ------------------------------------------------------------------------- NECESSARY PLANS IN DUPLICATE TO BE SUBMITTED HEREWITH In consideration of permit given for doing the work described in the above statement , wehereby agree to perform said work in accordance with the attached plans and specifications , which are a part hereof, and in accordance with the building regulations of the City of Atlantic Beach. St*gnature Contractor Date 9 Si-,nature O-,��erT Date DEPARTMENT OF BUILDING CITY OF ATLANTIC BEACH,FLORIDA PERMIT No.6465. PERMIT TO BUILD 740CKT) THIS PERMIT MUST BE POSTED ON JOB 4 r,5 *130CAC; Date 10-26 _19 84 r)64 III/Wilt Valuation$ BE-WW Fee$ 7-50 This permit not valid until above fee has been paid to City Treasurer,and is subject to revocation for violation of applicable provisions of law. This is to certify that SIKE GN FILMS 715 BM= RMD has permission tmbaild RE-WyW HOW AS PER MANS Classification WSURIrm Zone RS1 Owned by ';TIVM ray FUNT-1; Lot Block S/D House No. 318& 715 BOMA RM According to approved plans which are part of this permit NOTICE—ALL CONCRETE FORMS AND FOOTINGS MUST BE IN- SPECTED BEFORE POURING. PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE 0 Building material, rubbish and debris Z-f from this work must not be placed in public space, and must be cleared up and hauled away by either con- tractor or owner. NIM M_ MMIN ,,_�uilding Official. FOR OFFICE PERMIT DATE CONTRACTOR USE ONLY NUMBER PLUMBING ELECTRICAL SEWER voted "mod wd MWO Doc#M070-n913,OR BK 13851 Page 2055, Number Pages:1 Filed&Recorded 03/07/2007 at 10:41 AM, JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY RECORDING$10.00 OF Ruall lbrcfo* Tft undWSOW hereby k*nn yW act Impovernemb W11 be We to cartain red property.and In scoordowe wft Adoft 713.P4rkb Sbkfts.On tkwkV kftnnoWn is stEftd in slis Nod=of CwmwncwnwtL 1. Deso"lon of Real ftoperW. :16 &n f 3 2. General Desaipfim of hnipilownentr PlesWential reroo*V 3. Property Owned bir. Owneft m do,mitt in 11111111 SVAK Fee Sknpb. Name aid addrew of fee sk*lle So holder o1her 1hon Owrier 7he person(s)or"a)wto vA make said la- swirda under direct contact(s)am AIA Rq0ft CWqXM bY-- 4SWCSWM Aganft Beach,Fbi 32233 Telephone:(Wif)2494=9 Fee(91014)24943917 S. The narne and-A,,46—affwe surely an the pwpTwd bxW(If any�as pwAded under Section 71323.Florida 1=11 6- Marimmand , of anyMerjon,natift a bm for tM construction of 7. Penaw wilikin the Skft of designated by Oww upon ahm notices or odmw domxvwft may be Wved under Part I of ChwW?13.Fkx ShMes,W*A service stailconslUe servioe upon Owner. 8. The norm mW address otperson Oww mW desigpo at his option in addition to Massif b recelm copy of IWW*rKfte as proved under Section 713.13(t)(b),FWde SWfulis: 9. Expkwtion dda of Hod=of t is ow(11)yew for the deft of recording unlem O#wrwbe Wxftd- y SwombsLitim~' 10, ,ttqfr) dwyet,AAAr-J) ,=.--L by -uft1$P0M0r'WI H fa waurs added 72 AA 9,8100TARY SEALI i VVER F "Wamw BuILDING PERMIT APPLICATION SS CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach FL 32233 Office: (904)247-5826 * Fax:(904)247-5845 Job Address: Permit Number: Legal Description Valuation of Work(Replacement Cost) $ 3�w .tk) • Class of Work(Circle one): New Addition Alteration (:::::i;je� Move • Use of�xi�ting/proposed structure(s) Circle one): Commercia. Residential If an existing structure, is a fire sprink er system mstalled? (Circle one): Yes No N/A Is approval of homeowner's association or other private entity required? (Circle one): Yes No P Describe in detail the type of work to be performed: 4-F VL-�* 13-5 Property Owner Information N CZ Contractor Information: ComDanv: I- I I -) ,I' cin oij (S Nameof i� I i i ��1 � f""('I Qualifying,Agent: —41 Address: gf-1, Sft- -city W i3a State �F4- Zip 32-2 73 OfficePhone .1V769"In Job Site/Contact Number r3 qqj State Certification/Registration4 CCC_057�9cfq Office Fax# Architect Narne&Phone# Engineer's Name&Phone# A a he n ade n a d he k andi Ua a nd a d e a 'n a a n ha n e he s "t 0 T s co'nn'�,c d Prior to'tn� Pp c -Y n h e ec2es nu 38 17 P 0 4 0 8 8 1 3dic to, t isp t rnut t,'ne a ter work is 6 non hs a any s u T k dA p it s 0 rs, rs, 0 or s no n north 0 ri u t I. � i 'c e te �a n r'0 tr t 0 u ti c snst r 'o e,,rded or a andssned 'ri of s I et the and d a aw t 't,� or w n j ,W or 001S 0 r le eate a an r t Oro bing,S gn elis F ace B H o i r t lebeme't n ed e e 0 o'ta r lia�e 0 e nlit nd that all wor W'I()P r 0 , 0 0, void 'o k ,, 0,n ened thin 6 n th c"In'", I ot' ' I r r or I ctrl 0 PUM ed. I nd1rtand that se arate Permits in"t be e, red e cal rk Conditioners,e1c. 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. Ihere certi thatIhaver.ead and examined this application and know the same to be true and correct. Allprovisions oflaws and ordinances governing thi's�pe rvhvill te coniplied with whether qpecified herein or not. Thegrantingof .t does notpresuine to give authority to violate or cancel theprovisions oj any oyernit,,. 01theo federal,state, or local law regulating construction or the perforniance cons uction. Signature of Property Owner: ai-A'A010) Signature of Contractor: swojLqto and subscribed befpre S t �and subscri�e e me m�0M Zsoim Day of AA= 2CO i this M Day of VjyAr t4l Notary Public. otary Public: N COMMAI D00394390 EWW 3/V2009 J call-IM!000394390 1011118111 ftU(WO)432-4254: tvit"3=W9 rawill No" Inc ""620 Mees: krAW ftU W0432-4254: —-----------Flarlds NO Am.,Inc ....I(FR.. .............. DO NOT WRITE BELOW THIS LINE: OFFICE USE ONLY Review Result(Circle one):