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Permit Siding 1872 Hickory Lane 2012 `f` CITY OF ATLANTIC BEACH , , 0 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 � � ' "' INSPECTION PHONE LINE 247 -5814 N,' rr`ja', 5 Application Number 12- 00000509 Date 5/16/12 Property Address 1872 HICKORY LN Application type description SIDING PERMIT Property Zoning TO BE UPDATED Application valuation . . . 14919 Application desc SIDING Owner Contractor PIERSON THIS OLD BEACH HOUSE INC 1872 HICKORY LANE 428A OSCEOLA AVE JAX BEACH FL 32250 JAX BEACH FL 32250 (904) 249 -2904 - -- Structure Information 000 000 SIDING Permit SIDING PERMIT Additional desc . STUCCO Permit Fee . . . 125.00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 14919 Expiration Date . 11/12/12 Special Notes and Comments 2010 FLORIDA BUILDING CODE, 2008 NATIONAL ELECTRIC CODE *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. Other Fees STATE DCA SURCHARGE 2.00 STATE DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 125.00 125.00 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 129.00 129.00 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING PERMIT APPLICATION 1 CITY P ATLANTIC BEACH L SO() Seminole Road, Atlantic Beach, FL 32233 APR 30 2012 Office 004)247-582o Fax (904) 247 -5845 R Job .Address: /87Z 1 y L_A - ✓ Permit Number: M 7Q gE , rt 32,233 Leal Description Parcel # ?, - 7 - 2-'1 9- . ZS -29 C er- ,Qo- 1 s v A i i A 04« tZG 1,01 Za Floor Area of 0 Sq.Ft. 0 Sq.Ft Val ation of Work $ Proposed Work heated /cooled 0 non - heated /cooled c- 88 Class of Work (circle one): New Addition Alteration Repair Move Demolition pool pa window "door Use of existing/proposed structure(s) (circle one): C onfzne rctat Residential If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N i 'x' "': ° _ 4 t Florida Product Approval r i i-ttra . :j FILE COPS' For multiple products use product approval form '� w Describe in detail the type of work to be performed: I U �.. t v " if r.'6-: -9?-4-rc ,)4vvr - 77 // ,,; c Pi y‘,/(:(7/3 i 1 MG (, �� (z _� , f ,--7717 z 7 6077-4 `' AWL L '1it-yu,711/c "( c Ju j) %Ai' h w E�+ Z , 0 CA o Property Owner information: U q 0 A r� w Nq� A z A Nance: "DA J I EL- 4 N7 C'€E7 P(Gr25D ' Address: l g 7 /4 / c" w City ArlANT (3 MALI"/ Statc{L Lip 3 33 Phone q e' i- . 2 V- H�, - 7 .9/7 0 k L -Mail or Fax (Optional) A 0 W w a a) Contractor Contractor Information: ?� Company Name: 0 O , Agent: " QV ICA �� ��/KN l� /SE (ua�litt�in �1 *cnt: M I / Address: y A O 5C LZJLA AN/c, City giticsci.idjc.6E (5 State FL Zip S Z 2 j Office. Phone TOL(• ( 8 j •2 cs, DC=. Job Site Contact Number gr. .y_ c r(o2.5 3I ax # Gi35 2193 State Certification /Registration #__ CC1C "15_1210 Architect Name BSc Phone # Mortgage Lender Name and Address _ Application is hereby made to obtain a permit to do the work and installations as indicated 1 certilv that no work or installation has commenced prior to the issuance <4a permit and that all work will he per to meet the standards alai' laws regulating construction in this jurisdiction. This permit ' mill and soh' a work 1,v not ,,hatmeaccri nulun ATV 05/ if/nth V Or it i'■</Wrirleit, NI or work tv Sinpended Of" abandOned for a O'rithl of ,v<1 (6; months a t a nt ank alter uork Is ,ottuncik ed I inIdercfand that vtparate permuk mast bc snowed /or Electrical If Ork, Plumbing. Signs, II dls, Pools, Furnaces, Boilers, Beaters, 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. 1b,,,,b crtify that I have irt,1 and examinol this applitatna and Anon thc same to hi' (Mr and t olleel. .111 prm isi, ms I ■/ laws and ordinati, eti L>oVerning tiny /IN of hr/ri; krill by" Ontritied with Is ,<pecilied herein or nor I/o' granting ,n 0/01110! ciOe?" 104 fIrt•Slelnt to give authority to viohlh" or Can( t'l the prot ,o11 of any , 4bertederill. State, or Iota! law regulating ,,aistru, non or the 10 rformate, c ot topical?, ti,ot. - _-- t Signature of Owner Print Name DA P / E L P Sworn to and subscribed efore me this J ' t-i- ‘ Day of A 441, L.- . 201,2— Notary Public e q:"4- e„.......7,,... e•g; ' DONALD C. CONRAD, It BoEnMX:edP COM p 20 1 / Signature of Contractor Print Name Sworn to and subscribed before me this 1 .?• tr% Day of AC 0- ■ k--- . 20 1 '"'"'"`""a"•••••; •!* - Pt DONALD C. CONRAD, PI i , A ■,, ■ 14„ MY COMMISSION 1 DO 943224 EXPIRES: November 30, 2013 Notary Public Bonded Thru Notary Public Undenwitars .... % Arimilim.0411••■•■••••■■••■ re__.„/ Revised 01.26.10 s1 `� City of Atlantic Beach APPLICATION NUMBER �s Building Department ^, � � � a (To be assigned by the Building Department.) 800 Seminole Road j . , � Atlantic Beach, Florida 32233 -5445 ,/c — r0 9 " E " Phone (904) 247 -5826 • Fax (904) 247 -5845 �r j %' Email: building dept @coab.us Date routed: j 2 City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: / /7z. /7h1r L`21 Department review required Ye No /� ,Q Building Applicant:/ 5 ©/d /,- ? �& /-/ &s f a�Zoning Tree Administrator Project: c57 Public Works Public Utilities Public Safety Fire Services I �� �` I �� �4 t i � `"� .,� � 4'� 1 ii'� i s Sri � 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: Kpproved. ❑Denied. (Circle one.) Comments: BUILDINe PLANNING & ZONING Reviewed by: "n Date: -5 " Z 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 05/14/09 Doc # 2012107433, OR BK 15946 Page 294, Number Pages: 1 NOTICE OF COMMENCEMENT Recorded FULLER CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00 Permit No. / Z -- , /2 - CC}5 Tax Folio No. 1 .. C , L/' ' IC. 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. !.Description of property (legal description) 2 '- L a) Street (job) Address: 4 z' u ti �;�, r 4 c �, 2.General description of improvements: Y 3.Owncr Information a) Name and address: 7 1 Ai i 6 L., ° ' ti l '* . ; h) Name and address of fee simple titleholder (if other than owner) c) Interest in pfopeliy , 4.Contractor Information a) Name and address: ; ,,i 4 ; .1 c t L4. it " cct, rc r? T Co r V b) Telephone No.: Fax No. (Opt.) "? 5.Surety Information a) Name and address: b) Amount of Bond: c) x eiepho ie No.. 6.Lender Fax No. (Opt.) 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 he served: a) Name and address: b) Telephone No.: Fax No. (Opt.) o.iti addition to himself, Ovvirci .tesigaates the following person to receive a copy of the Lieiior's Notice as provided in Section 713.13(1)(b), Florida Statutes: a) Name and address: b) Telephone No.: Fax No. (Opt.) 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 PAYMENT'S MADE BY THE OWNER AFTER THE EXPIRATION OF'1'HE 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 OF COMMENCEMENT. St'AIT OF F'r.S)rirttA -,.. ,7 -, COU YTY OF PINELLAS 1 O ci; � -- �a"i Signature of Owner or Owner's Authorized Officer /Director /Partner /Manager „ ' ; DONALD C. CONRAD, b! ? .. fi ah :4; MY COMMISSION # DD 943714 A ' I e l.- ( e 6; n! 14...: ..,:.;‘4,1 EXPIRES: November 30, 2013 Print Name y � �� 4;i aV Bonded Thru Notary Public Underwdtera The foregoing ins' - A -- .7. -- : - .7 - 7 -- - this le day of A RRt 20 1A, by as (type of authority, e.g. officer, trustee, attorney in fact) for ` (name of pa on behalf of whom instrument as executed). Personally Known OR Produced Identification V Notary Signature Type of Identification Produced t (✓ Name (print) "y q...0 (• CbrJ2p. , OR Venfication pursuant to Section 92.S2S, Florida Statutes. Under penalties of perjury, 1 declare that 1 have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief. FORMS /NO('.rs sd201 0 Signature of Natural Person Signing (in line # 10.) Above