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Permit Bldg Repair Fire Damage 699 Seaspray 2011 4 CITY OF ATLANTIC BEACH a c , 111 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 -On - s INSPECTION PHONE LINE 247 -5814 -� Application Number 11- 00002766 Date 10/14/11 Property Address 699 SEASPRAY AVE Application type description RESIDENTIAL OTHER Property Zoning TO BE UPDATED Application valuation . . . 4000 Application desc fire damage repair Owner Contractor LEFT ELITE BUILDING CONTRACTOR 699 SEASPRAY AVENUE 55 FORESTAL CIR ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 (904) 247 -5561 Permit RESIDENTIAL ALT /OTHER Additional desc . Permit Fee . . . 70.00 Plan Check Fee . Issue Date 35.00 Valuation 4000 Expiration Date . . 4/11/12 Other Fees STATE DCA SURCHARGE 2.00 STATE DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 70.00 70.00 .00 .00 Plan Check Total 35.00 35.00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 109.00 109.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. a BUILDING PERMIT APPLICATION .. CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247 -5826 Fax (904) 247 -5845 Job Address: C c4 Ma A, Ve Permit Number: // -- L 2 g Legal Description . -- - ` � a ° '- Parcel # ��` r� t^ Floor Area of Sq.Ft. Sq.Ft Valuation of Work $ Proposed Work heated /cooled /9: al non - heated /cooled ' Class of Work (circle one): New Addition Alteration Rar Move Demolition pool /spa window /door Use of existing /proposed structure(s) (circle one): Commercial If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A Florida Product Approval # For multiple products use product approval form Describe in detail the type of work to be performed: a . - d) 0 ti iC , , ? rt, « -, ( A ' a 000: Ak, � Property Owner I f ormation:' `�� , p'' '' ' r Name: 1� t " . , 5- t.- 'x.4 Address: c � 'C"a '"''' - tea City ,filLITIM w State " • ip ,3, Phone J t r , >- E -Mail or Fax # (Optional) , ,: Contractor Information: \ , Company Name: I + " , I Lw �.LW1 Q0z445 k Quali ing A ent: rt e t*\ - " ri` e,c1 Address: •3, j IG (` - e."%z,, ( C t f 1 City 144 "t c -\ State / Zip j j Office Phone 'al17 °(A' I Job Site/ Contact Num! - - ___ . ___ _Tax • dk h — ;' r State Certification/Registration # t • ?^ h4• f i . ti , , • • _ _ Architect Name & Phone # _ i l ` ! . F , 1 Engineer's Name & Phone # I IC BEACH Fee Simple Title Holder Name and Address I SEE PERMITS FOR ADDITIONAL Bonding Company Name and Address ' III I LENTS AND CONDITIONS. E Mortgage Lender Name and Address I .. , I ? - 4094 A Application is hereby made to obtain a permit to do the work and installations as :mica e:. ._,., 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 ' ecomes 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. 1 understand that separate permits must be secured for Electrical ;York, Plumbing, Signs, Wells, Pools, Furnaces, Bo Heaters, Tanks 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. I hereby certify that 1 have read and examined this a placation and know the same to be true and correct. All provisions of laws and ordinances governing this type 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 provisions of any other federal, state, or local law regulating construction or the performance of construction. Signature of Owner /fr d- .,/Y ,/te Signature of C on t ractor / .-,.�- -f*" Print Name OF hOcet h /J L ,e411 Print Name C Sworn to and subscribed before me Sworn to and subscribed before me t ' /Z1 hDay of Oc; GE-ri , 20 !1 this (- 1flDay of Oct) /3 , 201 fil � , ' r � MARILYN IC BERRY this -- .r r , Notary Pub is „di\ BORES: MYCOMMISS I #EE064488 Notary , ;1 � r' " .,.'''' 1 _-'. . - MAR 28, 2015 EXPIRES: MAR 25, 2015 Banded through tit State insurance • , . ' , 1 , . ; , sed 01.26.10 pp ica • e o • es: 11 DO NOT WRITE BELOW - _ A OFFICE USE ONLY Review Result (circle one) �ing ore w evasions Approved Disapproved Approved w/ Conditions Review Initials/Date: Development Size Habitable Space Non - Habitable Impervious area Miscellaneous Information Occupancy Group Type of Construction Number of Stories Zoning District Max. Occupancy Load Fire Sprinklers Required Flood Zone Conditions /Comments: 1 , r! A.Nr City of Atlantic Beach APPLICATION NUMBER ` Building Department (To be assigned by the Building Department.) :� 800 Seminole Road �/ j� Atlantic Beach, Florida 32233 5445 / tv Phone (904) 247 -5826 • Fax (904) 247 -5845 / �� >%' E -mail: building- dept @coab.us Date routed: City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: o 9 9 Jf 'J — pf)Fv part nt review required 2 // Building �l// Applicant: � , jil / /oh n g & Zoning Tree Administrator Project: ! 4 Public Works Public Utilities Public Safety Fire Services r' ! x k r I� �G sa i � Y u � �" +'s, ,,�� p T" � n� 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: € PLANNING & ZONING Reviewed by: II/ Date: /© "/ TREE ADMIN. Second Review: Approved as revised. ❑De d. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 NOTICE OF COMMENCEMENT Permit No. ,il — 0774.6 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. De criiption of property (legal descrition of property and address if available): ✓1 / j f t 3(7' -as I �� _ r 9 37t' {? Sct4 r4`-v'C''_ 4 , - ,,'7' "ic yl l�G C� c Y` + 1. 33. 2. General Description of improvements: C J 7 7 t „ Cif NN- li.:W 4 c yl 4c i vA'shi V1 J 3. Owner Information: a) Name and Address: frb.4 fi - v !a z Le e Gt5 Odo V.4, b) Interest in property: .17C Ac \ tc ---6p ate 'I6,k c) Name and address of simple titleholder (if other than owner): 4. Contractor Information: %-�4Ne c1A 'C-N) „- a) Name and Address:u (�til��c�5� 1Vti�1� tc% 3,-,- N b) Phone Number: )f 3.9\ `' Surety Information: a) Name and Address: 6v 0! b) Phone Number: c) Amount of Bond: $ 6. Lender Information: a) Name and Address: NA- b) Phone Number: 7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as provided by 713.13 (1)(a) 7, Florida Statutes: a) Name and Address: b) Phone Numbers of Designated Person: 8. In addition to himself /herself, Owner designates of to receive a copy of the Lienor's Notice as provided in Section 713.13 (1) (b), Florida Statutes. a) Name and Address: b) Phone Number of person or entity designated by owner: 9 Expiration date of Notice of Commencement (The expiration date is one (1) 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 I, 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 WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. The foregoing instrument was acknowledged before me this / 7lay of OA'be2 20 '' err COMMISSION i a MY eaea�ee A a 1 C- .✓JW EXPIRES: MAR 25, 2015 Y PUBLIC, STATE OF FLORIDLY WOO trocli lit MN insurroo Print Name: 0/Personally Known ❑ Identification/Type: Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief. 4 N 0 Doc # 2011221630, OR 8K 15738 Page 1328, Signature of Property 0 Number Pages: 1 Recorded 10/12/2011 at 02:12 PM, JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00 Revised 10/1/2009