Permit Roof 379 1st St 2010 6'�: CITY OF ATLANTIC BEACH
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800 SEMINOLE ROAD
.� , � � ATLANTIC BEACH, FL 32233
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INSPECTION PHONE LINE 247 -5826
Application Number 10- 00001326 Date 11/01/10
Property Address 379 1ST ST
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 4985
Application desc
reroof
Owner Contractor
ERICKSON ACACIA ROOFING COMPANY INC
379 FIRST STREET PO BOX 1777
ATLANTIC BEACH FL 32233 ORANGE PARK FL 32067
(904) 298 -2170
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 75.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 4985
Expiration Date . 4/30/11
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 75.00 75.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 79.00 79.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
. ob Address: 37 9 / S / - 4 / /ri ' c 6-c c i, fz_. 3a,1-43 Permit Number: !
,egal Description t. F!2J is frt Parcel # /9 77 '1'O() F ea o Sq.Ft. Sq.rt
Taluation of Work $ 7 Cl Y rS Proposed Work heated /cooled / g'Is? non - heated/cooled /152_
:lass of Work (circle one): New Addition Alteration Repair Move Demolition pool/spa window /door .
fse of existing /proposed structures) (circle one): Commercial sidenti. -; ---
f an existing structure, is a fire sprinkler system installed? (Circle one): i o, N /A
lorida Product Approval # Fi. g,' -t'2,
or multiple products use product approval form
lescribe in detail the type of work to performed: Re at ,;c rwtd replace e Ai5'ti o55 tam 4 ete ivl iA) I t11 rip u)
4h1 '?,C. atat.-t . 30yr 11 re'
roperty Owner Information:
fame: , Jr -1 % / C. Address:CM /C /oc2 iacoc &z2 kS APo ilk 04/ S
ity 1 State Zip Phone?M —735- ci 70
-Mail or Fax # (Optional)
'ontractor Information:
ompany Name: G i o , , Ai Qualifying Agent: c I, , M ✓7 6T r -
.ddress: ?) -- V 1.5 ry 0 J City OrciA, - -t. 'ter-, State P. Zip 3a ° 73
■ffice Phone 70 a9 8.---.11 )O Job Site/ Contact Number C°()I-j - '{ -L11.6 Fax # 7oV a 5 R - cg./ 9 /
tate Certification/Registration # (: C / 344 8-y.01
rchitect Name & Phone #
ngineer's Name & Phone #
ee Simple Title Holder Name and Address
onding Company Name and Address
[ortgage Lender Name and Address
7plication 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
nuance 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
ul void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a_pertod of six 16) months at any time after
9rk is commenced I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters,
znks and Air Conditioners, etc.
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
1 COMMENCEMENT.
iereb certify that I have read and examined this a placation and know the same to be true and correct. All provisions of laws and ordinances governing this
9e of work will be complied with whether specified herein or not. The granting of a permit does not presume to give -•x to violate or cancel the
ovisions of any other federal, state, or local law regulating construction or the performance of construction
gnature of Owner( Signature of Contract. , .�. '.
■
int Name X filar/ (; r Lt5 U
rTh Print Name X CY1 VII KC Z
Worn to and subscribed before me Sworn to and subscribed before me
is Day • .eti' 1 this Da of ' — ,
�:'f' "•1 , DER M. BEAVER � DERRIC-KK .M. rBEA � I tVER Arm ,. _ DD 787538 /0G� • u u 7 . Not.W'r. is ' Expires May 12, 2012
ataxy 1 ,, BondsdThIu W s : :� Worms 800465 019 - 4, • • Nu Troy F Yrurnce8004e54Ol9
� icevisea. ui.2v.1u
SPECIAL POWER OF ATTORNEY
'1]flS IS A MILITARY POWER OF ATTORNEY PREPARED AND EXECUTED PURSUANT TO TITLE 10, UNITED STATES CODE,
SECTION 1044B, 13Y A PERSON AUTHORIZED TO RECEIVE LEGAL. ASSISTANCE FROM THE MILITARY SERVICES. FEDERAL
LAW EXEMPTS A MILITARY POWER OF ATTORNEY FROM ANY REQUIREMENT OF FORM, SUBSTANCE, FORMALITY OR
RECORDING THAT IS PROVIDED FOR POWERS OF ATTORNEY BY THE LAW OF ANY STATE, COMMONWEALTH, TERRITORY,
DISTRICT, OR POSSESSION OF THE UNITED STATES. FEDERAL. LAW SPECIFIES THAT A MILITARY POWER OF ATTORNEY
SHALL BE GIVEN THE SAME LEGAL EFFECT AS A POWER OF ATTORNEY PREPARED AND EXECUTED IN ACCORDANCE
WI'T'H THE LAWS OF THE JURISDICTION WHERE IT IS PRESENTED.
KNOW ALL PERSONS, that 1, JEFFREY M. LYLE, a legal resident of FLORIDA and presently residing at CMR
402 BOX 2285 APO AE 09180, desiring to execute a SPECIAL POWER OF ATTORNEY, do hereby appoint
MARY ERICKSON whose address is 4322 TIDEVIEW DRIVE JACKSONVILLE FL 32250, as my Attorney -in-
Fact to act as follows, GRANTING unto my said Attorney full power to:
Manage my real property located at 379 1ST STREET ATLANTIC BEACII FL 32233. Said attorney is empowered
to execute any and all documentation necessary to effectuate rental of said property and to collect rental for my
henefit.(The amount of said rental shall not be less than $1400 (One Thousand Four Hundred Dollars and Zero
Cents) per month.) Management shall extend to maintaining the property in a habitable condition and operating as a
prudent administrator.
TERMINATION: This Power of Attorney shall become null and void the 15 day of October, 2012 unless I
should become incapacitated; in that case, it shall remain in effect until revoked by me.
Notwithstanding my insertion of a specific expiration date herein, if on the above specified expiration date 1 shall be,
or have been, carried in a military status of "missing," "missing -in- action," or "prisoner of war," then this power of
attorney shall automatically remain valid and in full effect until sixty (60) days after I have returned to United States
Military control following termination of such status.
IN WITNESS WHEREOF, I have hereunto set my hand this the 15 day of October, 2010.
Jy !.YLL �—
STATE OF 1' ;: ' ;s; UNITED
MR FORCE
COUNTY OF 'i' t `)9094 -O325
On 15 day of October 2010, before me, Tonya Lee, Notary Public, personally appeared JEFFREY M. LYLE
personally known to me or proved to me on the basis of satisfactory evidence to be the person whose name is
subscribed to the within instrument-art&acknowledged to me that he /she executed the same in his/her authorized
c (ies), that by his/ 1ef ignatuye on the instrument, or the entity upon behalf of which the person acted,
executed mstni.
• ,, s"CATEs f
TONYr / `
J NOTAm
t7F 1 . 1 44 /ER
y C°A d1r ED,ET A x ES m
My Commission Expires: f V ({� f . A NoT AN att
14U 104 C
� 0 .4DVt3G
NOTICE OF COMMENCEMENT
Permit No. ,
Tax Folio No.
State of Florida. County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713. Florida Statutes. the following information is provided in this Notice of Commencement.
1. Description of property (legal descri l ion of property and address if in' i jab lc):
1:—..6 'Z Le f3 i k_ '3 AT uwT► .. -1+
2. General Description of improvements:
3. Owner a a n d Addr : ess: —p 7 .� L i 3 7 �y � y t S i '. � / G �. 1 , 4. &:
a) Nam .lt p a33( �' 10.1 -`' 617-( 617-( Sd
Name and Addr`Je� cy 7
h) Interest in property e )..... A
c) Name and address of simple titleholder (if other than owner):
4. Contractor Intorrmation:� L
a) Name and Address:r4-cm -cA,A. Rte- -+•.iC ( -,, ;...c Si 5 5,,,,..#17).1 a
h) Phone Number: 1 Let r .. ,j-0°+''`<i " 3z4.5'?
5. Surety Information:
a) Name and Address:
h) Phone Number:
c) Amount of Bond: $
6. Lender Intormation:
a) Name and Address:
h) Phone Number:
7. Person within the State of Florida designated by owner upon whom notices or other documents may he served as
n 0 k 8 C go provided by 713.13 (I)(a) 7. Florida Statutes:
O z m " ° * a) Name and Address: gr o { r- a , o h) Phone Numbers of Designated Person:
0 A F i ° 8. In addition to himself /herself, Owner designates of to receive
E, In .. � f1i . , a copy of the Lienor's Notice as provided in Section 713.13 (1) (h). Florida Statutes.
O m N - ' en' a) Name and Address:
x NJ
° o O h) ('hone Number ofpelson or entity designated by owner:
n 0 a7
55 a co 9 Expiration date ofNotice of Commencement (The expiration date is one (1) year from the date of Recording unless a
c - x different date is specified: --
"1 4
p ? w WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
c - o NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS CINDER CHAPTER 713, PART
m 1. SECTION 713.13, FLORIDA STATUTES. AND CAN RESULT IN YOUR PAYING TWICE FOR
o rn 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,
r- ('ONSIII,T WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING
YOIIR NOTICE OF COMMENCEMENT. M
)C Ali rl Ct',f,� >'�' r1
Stgnatur of 0(4. -or Owners Authorized Otficer /Direcutr /Partner/Manager Signatory's rated Name &Title /Office
Y
The foregoing instrument was acknowledged before me this 7 day of • 20 14 - by
lWi tt.• IL--' )•6.► as c., for .
(Name of P rson) (Authority Type. 1 e. Officer /Attorney) Mame ot•P y Instrument was Executed for)
g` DERRICK M. BEAVER
l In. Commission DD 787538 NOTA''P • i.ix. 'mss o .
'
Expires May 12, 2012 print Name:
* Bonded 'Nu Troy Fain Insurance 9063957019
' Personally Known .. z...,„ 5 7�
Identification/Type: Xk I Z S
Verification pursuant to Section 92.525. Florida Statutes. Under penalties of perjury. I declare that 1 have read the
Ioregoing and that the facts stated in it are true to the best of my knowledge and belief:
Signature of Natural Person Signing Above
Revised 10/1/2009