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Permit Porch Add 273 Pine 2011 l0 '' 1 �. \J'j jri'4 is. CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 -" 4 0.111 Application Number 11- 00002120 Date 6/21/11 Property Address 273 PINE ST Application type description RESIDENTIAL ADDITION Property Zoning TO BE UPDATED Application valuation . . . 15000 Application desc ADD SCREEN PORCH Owner Contractor FRANK, STACEY DEAN RUSSELL CONSTRUCTION CO. 273 PINE STREET 438 OSCEOLA AVE ATLANTIC BEACH FL 32233 JAX BEACH FL 32250 (904) 241 -3334 Structure Information 000 000 Construction Type TYPE I -A Occupancy Type RESIDENTIAL Flood Zone ZONE X Permit ELECTRICAL PERMIT Additional desc . Sub Contractor . LORE ELECTRICAL CONTRACTORS Permit Fee . . . 57.40 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 12/18/11 Special Notes and Comments Roll off container company must be on City approved list and container cannot be placed on City right -of -way. Other Fees STATE ELEC DCA SURCHARGE 2.00 STATE ELEC DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 57.40 57.40 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 61.40 61.40 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. ELECTRICAL PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd, Atlantic Beach, FL 32233 Ph (904)247 826 Fax (904) 247 -5845 JOB ADDRESS: Z 7 3 ' / /ye- -C PER MIT # - )� 6 J � r JEA INFORMATION REQUIRED ON ALL PERMITS ZOO AMPS 2 '10 74,VOLTS / PHASE VALUE OF WORK $ CO. erD NEW SERVICE n Overhead n Underground 1 U Underground up Pole ❑Residential (Main) Service ❑0 -100 amps ❑ 101- 150 amp s ❑ 151- 200amps ❑ amps # of Meters ❑ Commercial (Main) Service ❑0 -100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps ❑CT Service amps Conductor Type Size ❑ Multi- Family (Main) Service ❑0 -100 amps ❑ 101- 150amps ❑ 151- 200amps ❑ amps # of Unit Meters ❑Temporary Pole ❑ amps SERVICE UPGRADE ❑ amps ❑ CT Service amps NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.) ❑ 100 amps ❑ 150amps ❑ 200amps ❑ amps El CT Service amps ADDITIONS, REMODELS, REPAIRS, BUILD -OUTS, ACCESSORY STRUCTURES, ETC. Outlets /Switches: 2— 0- 30amps 31- 100amps 101- 200amps Appliances: 0- 30amps 31- 100amps 101- 200amps A/C Circuits: 0- 60amps 61- 100amps Heat Circuits: # circuits @ kw Number of Lighting Outlets, Including Fixtures: OTHER ELECTRICAL PROJECTS ❑ Swimming Pool ❑ Sign ❑ Smoke Detectors _Qty ❑ Transformers KVA ❑ Motors hp FIRE ALARM SYSTEM (Requires 3 sets of plans & Fire Alarm Checklist) Qty volts /amps VALUE OF WORK $ REPAIRS/MISCELLANEOUS ❑ Replace Burnt/Damaged Meter Can ❑ Safety Inspection ❑ Panel Change ❑ OH to UG ❑ 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 this 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 �IG i'+'/l Phone Number Electrical Company 4/1-6 34 6 �� 7 c ! J/v'(. Office Phone Fax Co. Address: D /7/41 dav�' City P/ U State ?7 Zip Je License Holder (Print): / %id/I6Z �-�s/�r� , State Certification/Registration # / 3d/3d Z Notarized Signat , ;1 ir acen i I irrilrf% .` L�I".— ; ti _� �, MY COMMISSION # DD 60 i A EXPIRES: F , z td subscribed befe this :. '� • y of VII . - 20 17 ' s , Roar* Nu Notary ere . "' ignat of Notary Public �_ am ✓�y(III `1, CITY OF ATLANTIC BEACH x y 800 SEMINOLE ROAD = . . ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247 -5814 F' Application Number 11- 00002120 Date 6/01/11 Property Address 273 PINE ST Application type description RESIDENTIAL ADDITION Property Zoning TO BE UPDATED Application valuation . . . 15000 Application desc ADD SCREEN PORCH Owner Contractor FRANK, STACEY DEAN RUSSELL CONSTRUCTION CO. 273 PINE STREET 438 OSCEOLA AVE ATLANTIC BEACH FL 32233 JAX BEACH FL 32250 (904) 241 -3334 Structure Information 000 000 Construction Type TYPE I -A Occupancy Type RESIDENTIAL Flood Zone ZONE X Permit RESIDENTIAL ADDITION Additional desc . Permit Fee . . . 125.00 Plan Check Fee . . 62.50 Issue Date . . . Valuation . . . . 15000 Expiration Date . 11/28/11 Special Notes and Comments Roll off container company must be on City approved list and container cannot be placed on City right -of -way. Other Fees STATE DCA SURCHARGE 2.00 DEV REVIEW - SINGLE & 2 -FAM 25.00 ���r�. ENG REV PRE APP > 3 HRS 100.00 ���� ) STATE DBPR SURCHARGE 2.00 UTIL REV PRE APP >3 HRS 25.00 Fee summary Charged Paid Credited Due Permit Fee Total 125.00 125.00 .00 .00 Plan Check Total 62.50 62.50 .00 .00 Other Fee Total 154.00 154.00 .00 .00 Grand Total 341.50 341.50 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road ••! Atlantic Beach, Florida 32233 -5445 Phone (904) 247 -5826 • Fax (904) 247 -5845 .r.:/, E -mail: building- dept @coab.us Date routed: c22 // City web - site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: c 3 1 1 r Dapartmeht review required Yes No Applicant: � M�iiO M 6Tr ()W , (Planning & Zoning) Tree Administrator Project: /7 i ' b /tag to ,) ' e rr f7 76ic N CfPu W c� P_ublic Utilities fi 171 - l Public Safety Fire Services Review fee $ - - faept Slgture �; .. „F ,r Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District fll. Es Army Corps of Engineers Division of Hotels and Restaurants C Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: DApproved. ❑Denied. FIL (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by: F I L, E COP te: TREE ADMIN. Second Review: Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ['Denied. Comments: Reviewed by: Date: Revised 07/27/10 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH ` / 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247 -5826 Fax (904) 247 -5845 /' fob Address: 2 73 l '. 1 Permit Nn , er: iiega1 Description 55 Z % 5.4 /7 / ...5 c_... 3 P arcel # � o. Floor Area of Sq.F't. S .Nt Taluation of Work $ ! j © Cf0 . — Proposed Work heated/cooled --- -& non- heated/cooled 23 :lass of Work (circle one): New Addition Alteration Repair _ Move Demolition pool/spa window /door Tse of existing /proposed structure(s) (circle one): Commercial ,.. Resident . f an existing structure, is a fire sprinkler system installed? (Circle one): -- Yes_ / 4 o N /A lorida Product Approval # i._. Ca ` i _ 51-1/ • /4, # j0 e / or multiple products use pro i uct approva rm ��`` • )escribe in detail the type of work to be performed: c c� N j c.. -6) v i c -�t f / -* ) 'roperty Owner Information: � - fame: 77 4 ! / Address: 2-7 d /A/R-.. SI _ ity / �. i Q -{� State / Zip 3Z- Phone G 5'6" 2.6 /7 -Mail or Fax # (Optional) ' ontractor Information: ompany Name: d7t C . f 0 Qualifying Agent:-tz.Cc. i�/SSe. (/ .ddress: T�, D y f el/ C r a.e _ ._ C i Qi'C " cc / State , 7 Zip 32-z-56 'fce Phone 2 €741 _ 3 3 3 y Job Site/ Contar:t Niimb 3_57 - 5 Fax # 2-S// - 2.4 tate Certification/Registration # C/7, c. 3/ ' 6,,.., - - --- rchitectName & Phone # _- -- /,; u _ ,A,d • agineer's Name & Phone # �� 6.4(4. /t) P� - a2E ' nc 1�.7 $ - ©J C.` 3e Simple Title Holder Name and Addre s ' T onding Company Name and Address /4.) [ortgage Lender Name and Address r ) 7_ 4 plication is hereby mod 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 pe ormed to meet the standards' of all laws regulating construction in this jurisdiction. This permit becomes null !d void f work is not commenced within six (6) months, or if construction or work is ended or abandoned fora er od of six 16) months at any time after irk is commenced I understand that separate permits must be secured for Electric - Work, Plumbin Signs, Wells, Pools, urnnrar, Boilers, Heaters, inks 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 COMMENCEMENT. :ere by certify that .1 have read and examined this soplication and know the same to be true and correct. All provisions of laws and ordinances governing this )e of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the 'visions of any other federal, state, or local law regulatin construction or the performance of construction. gaature of Owner Aril_ 1\ I A Signature of Contractor (12 i'et-p-s mt Name Print Name Q (J,5 e ._ • vorn to and subscribed before me) Sworn to and subscribed before me is �' Day of , i lV1.c4 V 1.,,/ , 20 1 1 this t -4 -hDay of /� a 20 .1 *.� _ _ _ � ,ice ki -- � rYT � � � a� Mary Public =o ,�P Q c . c ,-,0 1 plies. Notary Public State of Florida • _ T A MNikin { ;• My Commission DD988003 9 My Commission DD988003' t EOF �,o Expires 05/03/2014 - Revised 01.26.10 FOFe, °a Expires 05/03/2014 j!..44 City of Atlantic Beach +► � APPLICATION NUMBER r i � � Building Department , (To be assigned by the Buildin Department.) l " S i 800 Seminole Road ` v . „; , ,i , N1 Atlantic Beach, Florida 32233 -544 Mk' • 9 /1 a Phone (904) 247 -5 • Fax (90 47 -5845 t /� "' 01 E -mail: building- dept @coab.us * ?' . —__ Date routed: �/Z 4 / // City web -site: http: / /www.coab.us APPLICATION REVIEW AND T ACKING FORM ? 11 Property Address: c27 R7 ) s r !.;„„.1.1 , t review re • uired Yes No Applicant: Atr -- ASS f// 1 6T"k ;Planning & Z Trtee -Ad •' . • istrator _- Project: 4 . S z /14 <Se t ?Oro I P lic_Utilities *irY Public Safety Fire Services _- Review fee $ ' r'" ' ! Dept Signature - . 0 Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: j 4 pproved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING & ZONING A o/43� /t Reviewed by: Date: TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. P , : j�; Comments: C U TILITIES ( .5-7--.3-- • • : - • FETY Reviewed by: Date: FIRE SERVICES Third Review: Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07/27/10 , tir^ s t..i. , City ` ty of Atlantic Beach �'`� APPLICATION NUMBER ' , Building Department 4. (To be assigned by the Building Department.) `_J F. '• Atlantic 800 Beach Seminole , Road Florida 32233 - 544. . v).. f ill / f ,9 f Phone (904) 24 -5826 • Fax (904) -- =_ ` Date routed: ��z // `. ,�). E-mail: building- dept @coab.us City web - site: http: //www.coab.us APPLICATION REVIEW AND TRACKING FORM - P11 — /Z Property Address: 7.3 -4 Si: D t review required Yes No Applicant: A. 165-''k()17M Planning &Zoning) Tree Adr istrator Project: ,4i /✓t tJ j'e rf t Ole 4 _ (Public Works (Public. Utilities b err' _) Public Safety Fire Services Review fee $ / a{ QeptSigature w a : Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: Approved. ❑Denied. (Circle one.) Comments: 4 Az/ BUILDING �! PLANNING & ZONING by: * 1 Date: s 2-u 1 Reviewed by. /� TREE ADMIN. Second Review: ['Approved as revised. ['Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ['Denied. Comments: Reviewed by: Date: Revised 07/27/10 BUILDING PERMIT APPLICATION 1 . CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 ! ■ r} ' t Office (904) 247 -5826 Fax (904) 247 -5845 "' p f p I1 _: i fob Address: 2- 73 j i .,,J c - Permif N er• j 24 .iegal Description Gv-" 5 Z `/ ‘...534/7 /2 S.e c ,, , 7j _ .._ Parcel # TaInation of Work $ 1 j / 0lj0 0° Floor Area of Sq.Ft. S Ft . l Proposed Work heated/cooled - non- heated/cooled Z' r :lass of Work (circle one): New Addition )Alteration Repair _ M ove Demolition pool/spa window /door Ise of existing /proposed structure(s) (circle one): Commercial k. F Residen: . f an existing structure, is a fire sprinkler system installed? (Circle one): - - • 4 o N /A 1orida. Product Approval # i _ 5/q - , #/0er- 7 ,L: / 'o r multiple products use product approva :rm )escribe in d e t a i l t h e type of w o r k to be p e r f o r m e d : C g ck' N kJ / G \ -6)c /c 4 Adel / - roperty Owner Information: • f • ame: j�� /,4 AJ /4 Address: 2.7 ,j dv ?A/�, S ity / J , c. /I 4 State/ Zip 3,Z'266. Phone G 5 - -- 2- /7 -Mail or Fax # (Optional) ' ontractor Information: ompany Name: -e / ,Z e// 67 C 1. Qualifying Agent: 4c - tecf //t5-.. (7 .ddress:. sI • i c/e. _ -_ • City r� State Y Zip 32-z-50 .ffice Phone 2'f ( 3 3 3 y Job Site/ Contact Numb . 3_57- 5 2 :::: Fax # Z'7/ - .Zd .2-vs" tate Certification/Registration # c, , c_ 3 /7 G rchitect Name & Phone # c �,41. / ny.,a _Qt&sira '-f$, - 7s 57 agineer's Name & Phone # e.o// 614.2 -7t e,2_- - r ./:-.4 ' r ©? y 5e Simple Title Holder Name and Addre';q' . �.y� p onding Company Name and Address /tJ [ortgage Lender Name and Address A °� plication 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 d void f work is not commenced within six (6) months, or if construction or work is su.goended or abandoned fora er od of six (6) months at any time after ork is commenced I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnnrac, Boilers, Heaters, inks 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 COMMENCEMENT. :ereby certify that .1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this ze of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the ovisions of any other federal, state, or local law regulatin construction or the performance of construction. gnature of Owner Atq lA Signature of Contractor (.2 # int Name Print Name .('' ,i.) - g c/.%.-5c ri vorn to and subscribed before me- Sworn to and subscribed before me is 110- Day of /ti1 rtq,,= ' , 20 E / this t TDay of A G� , 20 t Mary Public o " WW 6~140 P Notary Public State of Florida ? • C • = r T A Milikin :' i My Commission 00988003 v a s My Commission D0988003' ,or „ Expires 05/03/2014 Revised 01.26.10 'or F,.o Expires 05/03 /2014 MAP SHOWING SURVEY OF LOT 529, SALTAIR, SECTION NO. 3, AS RECORDED IN PLAT BOOK 10, PAGE 16 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. ■ 1 Fau ✓0 .5/,,,, � ✓ —. I ` " 0 1,.-- ,FDciNO 9/4 •' /rte../ zc> � 3'x l 6'''' F' 9=\ 7cP nk i''p4 t, _ _ 4 ..1..6:t1-1- . G7 ' 7 . B, S 2 sTb RY - s 7ar? Y X 2 8 \ 2 FA.Zc�4'�E u: ,.io. 27� N Q o � y N S° l/ M 1 v s : � 7/T7 ci Ia 1 N Y k 1. m ' •Ili a noe ^Pro / T 1 , ' v . 0 t ,+=-04.4..." o f A7/n/e Tz?ef. / 5''R„r,- /../OTC: . •MpE`iZ ✓r.." 0.5; Rt°c�e•e. AloveA,P3e•.z 2G, 4979 ��-�.4 /Gc.� T / a �/ ._ ..�._,w....... .,. _v < . /O .3Ri..i� s.J.tvE>- u�To O.a jz• Neri!) !'��+y�,e�.-- � ..._ \ .. -- , ,, r ' / d 4 s,.,, `T74 / — 7, cetelc2., ( -- 7G - 7 7, ,c 40 -./ 1 ^> . 0 - ./ 1 " / .t..,.,,„, S dote S. ,f; f H. A. DUR ��� = ' 3 7%" DEN & ASSOIATES -- �-�- REGISTERED SURVEYOR NO. �l4.FLA. LAND & HYDROGRAPHIC 1\ SURVEYORS /4 POST OFFICE BOX !!0870 -� SIGNED �L /A/Ar /y 19 '� j S8 8TH STREET SOUTH _ JACKSONVILLE BEACH, FLA. 32260 SCALE: �� - 'Za • • B3G4 - BB3° , Y' 5±,:1,`1 , City of Atlantic Beach APPLICATION NUMBER v i � ' Building Department (To be assigned by the Building Department.) ` x '� 800 Seminole , Road / ^ '" ' : 71 : : Atlantic Beach Florida 32233 -5445 /f /�' �� � Phone (904) 247 -5826 • FFax (904) 247 -5845 j _%� E -mail: building - dept @coab.us Date routed: c /20/1/ City web -site: http: //www.coab.us APPLICATION REVIEW AND TRACKING FORM ?Ii Property Address: 4 . 92 7D / / 7 J � S r t review re • uired Yes No r = Applicant: 9 f t r - A S S T / / G On Z Planning & o T Tree- Administrator Project: A D /1 tJ J'e rf t ?or - P ilic.Utilities h' ? Public Safety Fire Services Review fee $..V :34f' i Rep Sl9. ture ..: } x" Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: ❑Approved. ['Denied. (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed Date: TREE ADMIN. Second Review: �pproved as revised. ['Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: ' ■- Date: 23 FIRE SERVICES Third Review: Approved as revised. ❑De ' d. Comments: Reviewed by: Date: Revised 07/27/10 k MAP SHOWING SURVEY OF LOT 529, SALTAIR, SECTION NO. 3, AS RECORDFf IN PLAT BOOK 10, PAGE 16 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. Qe 1J' 1 0 D IO' A Fdui✓O 9/4 "h.Ze,../ 1 3'x'6 gyp i P II �I'1 11 • ._�at i.‘4. �.7' t B.9 28 2 � Td,i - ? r ` m n/d. 273 N O , P7 3 ° LO _ N rn kl N ki (/ k ) Q \ • ^ 4,7 q0 : I k iq N Y K� J 9 /2.7' V. s. — t 3' � A ,. .coui✓.. D /4'irza/./ -.- 9� City of Atla A :7/4/ G' L a nd 2 Be ach T a o v vi ce with applicable ° 'Afrt zoning, subdivision .3 g and other locui development re lac.;! ulatio s, but do f�s not constitute ,A./07-4---: c. S/I4P4 -12.1/ �� .r a fpr v ifor the ` ~ ' an e o rmits. Compliance Re°cs./ -c"<e i, •^/ovE,.- fvstt2 2G, /979 �,, (/ ,/ r ...._._ . to C. o ► G� all other a 77' R/••"2 $.iJre.iey 1/r'Td pile.. A' k) -4,- +"'+�, . Stag b y s i gn a t ur efo f t h r applicable r T b e�.verlt4e d b g equirerrrents I g f , y signature of the City o` Atlantic /� c l O ial prior to th e$'7 i , fir✓ /,:}, "fer / • �in¢,, mit. ance of a Z7/2/ // ' A - 4: —144,61 A- 444A.1/4. Commu r 2 t Director • x c?, 5" elder S', , , 1. u �.. ie: '3 5,3 r . A. 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No. r'r ` _'_gy Tax Folio No. State of.a�j #741 County of . �r 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 la stated in this NOME OF COMMENCEMENT. 169x1 description of property being improved; 63"7 529 Address of property being impmved:. . jr /ii F - General description of improvements; S Owner C t c l J'4141 — Address '7y3 r 1 3.. --2- ►4 • Owner's interest in site of the improvement .— i ■ Fee Simple Titioholder (lf other than owner) _ 4 � Name • Address , d Contractor /! ffiA P/4tr c- ielLifiLik J Address .� i, d 32/2.-572 Phone No. - ''» J l/ Fax No. _— _� Surety (if any) Addross Amount of bond $ Phone No. Fax No, Name and address of any person making a loan for the Construction of the Improvements, Name Address AJ 1 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 Phone No. Fax No. - In addition to himself, owner designates rho following person to receive a copy of the Lienor's Notice as provided in Section 713.06 (2) (b), Florida Statutes, (Flit in at Owner's option). Nome Address • Phone No. I - Fax No. _ — Expiration dalo of Notice of Commencement (the expiration date is one (1) year from tho date of recording unless o different date is specified): THIS SPACE FOR RECORDER'S USE ONLY OW ER 1 Si nod: ' * • r rJ /if g • -to: Before me this • •a j of I�A �1( In the -. County of Duval, Slate of,,florida, has personally appeared ---- j.skQ I Page 2312, —VVV Numxr Pages 1 Notary Public at Large, State of Florida, County of Duval RecordPd O61012011 at 12:113 PM. JIM FULLER CLERK CIRCUIT LOUR 1 DUVA!_ My commission expires: COUNTY w Personally Knon $10 q�ub6c 5taleof Florida RECORDING Produced identification A . y • fission 00988003 4 Expires 05103!2014