Permit 452 Osprey Key ; ►° - ' ° , CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
� w ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 10-00000489 Date 4/22/10
Property Address . . . . . . 452 OSPREY KEY
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
12 FIXTURES
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Owner Contractor
------------------------ ------------------------
HUTCHINSON MIDWAY SERVICE, INC (PLBG)
452 OSPREY KEY 4677 118TH AVENUE N
ATLANTIC BEACH FL 32233 CLEARWATER FL 33762
(727) 573-9500
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Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Permit Fee . . . . 139 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 10/19/10
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 139 . 00 139 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 139 . 00 139 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
4 PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845
,TOB ADDRESS: 2 VS 4_'2 2ZZ3 PERMIT#
13
NEW OR REPLACEMENT INSTALLATION: Project Value$ Y . °
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal Z?K ��/�
Kitchen Sink Vacuum Breakers �S
Laundry Tray Water Connected Applia �s 2ZQ�
Lavatory Water Heater 0
Other Fixtures Water Treating System
RE-PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub r Septic Tank&Pit
Clothes Washer l Shower /
Dishwasher _J Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet E_
Hose Bibs Urinal
Kitchen Sink / Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Z Water Heater f
Other Fixtures Water Treating System
MISCELLANEOUS:
Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons(Requires 3 sets of plans)
- Lawn Sprinkler System-Number of Heads 11 Well
SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
Other
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.I hereby certify that I have read
.his application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified
or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name Phone Number 9ja2-
Plumbing Company iJtdGua.!-/ Office+Phone 727-575Fax 72Z-g3-6-2)eJC^
Co. Address: / �>�'1 City_(�IP.t� ea2 StateL Zip 7(0 7
License Holder (Print): v1 wt 1106
to Certification/Registration# CFUZIj 9/
Notarized Signature of License Holder
Sworn and subscribed for o2� da 20 AD
JACQUEUNE M.DUBE S1 ature of Notar Publi
MY COMMISSION#DD 905985 _
EXPIRES:Jul 25,
Bonded AN Notary Public Underwriters
Doc # 2010090728, OR BK 15220 Page 1056, Number Pages: 1, Recorded
04/22/2010 at 10:16 AM, JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY RECORDING
$10.00
NOTICE OF COMMENCEMENT
Permit No. —
Tax Folio No.
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property,and in accordance with Section
713.13 of the Florida Statutes,the following information is provided in this NOTICE OF COMMENCEMENT.
1.Description of property(legal description):
a)Street(job)Address:
2.General description of improvements GtzQjJ
3.Owner Information /
a)Name and address:�;(rr/r/irisnn '1/u52 OSS ORtu w�i� I-Sue •1; �C 3223 3
b)Name and address of fee simple titleholder(if other than owner
c)Interest in property
4.Contractor Information ��
a)Name and address:�,� y,d j e;.Z;le 44i 77 Ilk-""7 f& &IeA a Amea& ISG 337t%�2
b)Telephone No.: 12 7-t-LZ 3 7:5pn Fax No.(Opt.)
5.Surety Information
a)Name and address:
b)Amount of Bond:
c)Telephone No.: _Fax No.(Opt.)
6.Lender
a)Name and address:
Phone No..
7,Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a)Name and address:
b)Telephone No.: Fax No.(Opt.)
8.1n addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.13(l)(b),Florida Statutes:
Ag,AbtA,
a)Name and address: 16774 i�n
b)Telephone No.:_71 7-S73- Fax No.(Dirt.). -
9.Expiration date of Notice of Commencement(the expiration date Is one year from the date of recording unless a different date
Is specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART 1,SECTION 713.13,
FLORIDA STATUTES,AND CAN 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 YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE COMMENCEM T.
STATE OF FLORIDA
COUNTY OF PINELLAS I O•
Si re of Owner or is uthorized OrFicer/Director/Partner/Manager
rint Name
The foregoing instrument was acknowledged before me this day of t7R __,20\1 ,by
as (type of authority,e.g.officer,trustee,
attorney in tact)for (name of parry on h of whom strument was executed).
Personally Known_OR Produced Identification ✓ Notary Signature
Type of identification Produced Name(print) 0""k 9'a'71 M U V1 C
OR
Verification pursuant to Section 92.525,Florida Statutes.UndeW7.7 p attics of perjury,I declare that 1 have read the foregoing and that
the facts stated in it are true the best of my kitmt llFlofids
bgtie.
ALMIRZAJIMOVI
FORMSNOC^4010 ` k Notary Public•State of �MyCommfufonExpiresAp 'stgrmtumra atura rsonSigning(inlineN10.)Above
Ctxnmlalion 0 DD 6BondedNoolhNgilwalN
TATE OF FLORIDA
LJVAL COUNTY
L THE UNDERSIGNED Clerk of the Circuit COItrt,DaVal County;
11;,rid0, DO HEREBY ERTIFY the within and foregoing is a true
::d corma I as it appears on record and fila
I: ire o f al Count Florid
o .
Cle
f i
ourt
Ftc 20
�-' A FULLER.
I uit COU
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D n oid
V r rr�0 7 ._
.° L'Cputy