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705 Sabalo Dr (vault) CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FLORIDA 32233 LINE 247-5826 INSPECTION PHONE Application Number . . . . . 03-00026177 Date 5/30/03 Property Address . . . . . . 705 S)ABALO DR Tenant nbr, name . . . . . . STUCCO SIDING Application description . . . SIDI G Property Zoning . . . . . . . TO B UPDATED Application valuation . . . . 200 Owner 1 Contractor ------------------------ ------------------------ CAMPOS, MANUEL & MARINA OWNER 705 SABALO DRIVE ATLANTIC BEACH FL 32233 (904) 249-5199 ---------------------------------------- ----------------------------------- Permit 13UILDING PERMI Additional desc . . Permit Fee . . . . 70 . 00 Plan Check Fee 35 . 00 Issue Date . . . . Valuation . . . . 200 Fee summary Charged Paid Credited Due ----------------- ---------- ----------- ---------- ---------- Permit Fee Total 70 . 00 70 . 00 . 00 . 00 Plan Check Total 35 . 00 35 . 00 . 00 . 00 Grand Total 105 . 00 05 . 00 . 00 . 00 BUILDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK MUST NOT I 1E PLACED IN PUBLIC SPACE,AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOROR OWNER- "FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPRONEMENTS"ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOL ATION OF APPLICABLE PROVISIONS OF LAW, BUILDING OFFICIAL CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FLORIDA 32233-5445 TELEPHONE:(904)247-5800 FAX:(904)247-5805 SUNCOM:852-5800 http://ci.atlantic-beach.fl.us PLAN REVVE"' 60MMENTS Permit Application # I C) 3 - ZCP 177 Applicant: A P'R-1 A r^t-kpoz Address: —7 C.) ':—!> S P, Project: =Fi r "a i L C6"-Your application is approved o Your permit application has been reviewed the following items need attention: Please re-submit your application when these item have been completed. t-30/e, Reviewed b Signed Date Contractor Notified Date CITY OF ATLANTIC BEACH SIDING PERMIT APPLICATION Date: Q47A 0 �o z Job Address: Owner of Property: Address: Zo-5- elephone: Legal Description: Block Number: Lot Number: Zoning District: Siding Contractor: C-6 lvleq_/� - Contractor's Address: 24 47-4-40_1e) Telephone: ;LO� Fax: Describe proposed use and work to be done: -S 7-V "s jpr- /Vep/ilz 7z fV7- Q-4-e—t4lie-IZ& 4477-K Present use of land or building(s): S/ P/A,46- Valuation of proposed construction: Is approval of Homeowner's Association or other private entity required? If yes, please submit with this application. Procedure: In order to expedite issuance of permits, please follow all steps and provide all information as appropriate Incomplete applications may result in delay in issuance of permit. Step 1. Attach detailed information on product to be used. Step 2. Attach details concerning attachment of product,i.e.,fasti ners,etc. I hereby certify that all information provided with this application is correct. Signature of Owner: _F1 aw ItA 1_A4 Date: A I hereby certify that I have read and examined this application and know he same to be true and correct. All provisions of the 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 federal,state or localrules,regulations,ordinances,or laws in any manner,includingthe governing of construction or the performance of construction of the property. I understand that the issuance of this permit is contingent upon the above information being true and correct and that the plans and supporting dal a have been or shall be provided as required. Signature of Contractor: —Date: 800 Seminole Road -Atlantic Beach,Florida 32233-5445 Telephone: (904)247-5800 -Fax: (904)24 7-5845 -http://www.ci.atlantic-beach.fl.us Page 1 Revised 1/17/03 Address and contact information of person to receive all correspondenoe regarding this application (please print). Name: Mailing Address: -skOA-(-z Dig! 4d7/_-4Wr/c x Telephone: E-Mail: AS TO OWNER: Sworn to and subscribed before me this C.;g _r11 da of A/A 20- State of Florida,County of Duval Notary's Signature:,,� Uk_Ck/j-1A,_ U rpg, JENNIFER SCHWETER Personally known 46KNI's MY COMMISSION#DD 121301 -ntification Produced id, �1- EXPIRES:May 27,2006 Type of identification produ ;q(/) BMW Thru NMry Pubw Unwrwriters ced AS TO CONTRACTOR: Sworn to and subscribed before me this day of 20_. State of Florida,County of Duval Notary's Signatt re: Personally known Produced id.-ntification Type of identification produced 800 Seminole Road -Atlantic Beach,Florida 32233-5445 Telephone: (904)247-5800 -Fax: (904)24 7-5845 - http://www.ei.atiantic-beach.fl.us Page 2 Revised 1/17/03 N C, 101 CITY OF ATLAIS TIC BEACH 800 SEMINO1 E ROAD ATLANTIC BEACH, FLORIDA 32233 INSPECTION PHONIf LINE 247-5826 Application Number 03-00026039 Date 5/21/03 Property Address . . . . . . 705 SABALO DR Tenant nbr, name . . . . . . REROOF Application description . . . ROOF Property Zoning . . . . . . . TO 3 UPDATED Application valuation . . . . 34SO Owner contractor ------------------------ ---- -------------------- CAMPOS, ANN MARINA ARLINGTON BEACHES ROOFING 705 SABALO DRIVE 1441 CESERY TERRACE ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32211 (904) 744-8888 Permit . . . ---------- . . . ROOF PERMIT Additional desc Permit Fee . . . . 75 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 3450 Fee summary Charged P�Lid Credited Due -------:----------- ---------- ----------- ---------- ---------- Permit Fee Total 75 . 00 75 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 75 . 00 75 . 00 . 00 . 00 BUILDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER. "FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS"ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF TI-flS PERMIT AND SUBJECT TO REVOCATION FOR VIOL�kTION OF APPLICABLE PROVISIONS OF LAW. BUILDING OFFICIAL CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FLORIDA 32233-5445 444 TELEPHONE:(904)247-5800 FAX:(904)247-5805 SUNCOM: 852-5800 http://ci.atlantic-beach.fl.us PLAN REVIEWCOMMENTS Permit Application 0`3 —0,(P C� _5 Applicant: Address: Project:– o Your application is approved a/your permit application has been reviewed ind the following items need attention: Please re-submit your application when these itemq have been completed. Reviewed by Eo L V Signed —Date Z.: 0-3 Contractor Notified Date 05/12/2003 12:45 9047450000 ARL 13CHS PODFING PAGE 02 CITY OF ATL4NjlC BEACH ROOFING PERMIT PPLICATION '7 Daft r^~of Pn)p"---eno COW30or ARILZNCTOM BEACHES RODFZN(; —T _Ufa Lk~Plwow.- CCC1325530 COWA~'s Ad*.w ,!:._ 141) X&JERY JERRAQ _ jACXSONVILLE FL-- 32211 T&plww, 7 4 4 P".- 745-0000 Vahm4oft of work; L fto 2:12 Los d"2:11 A ffln, &0 PrOdum Timbetlira)- ^i 1,nj b(mWklum Mumple.-GAF): ASTM Defilnuict4s): R4q*W IMP9010m; Dow AS TO OWNZA. hnuw*ij-- dayet Sum is md svwbw bet&#a"*is Sm OrFww&,commly orpow Navy's Sipewm- ,ftp.vmwi,y �w poodowd wom&SAN Expmw oclow to.no amis Poe AWW17:;�-J".10 AS TO CON?UCTOIL. I S%W%W Md Nb&ibed befae Mg Oki$ or Sm ofFWA-4 Comly of DwM Wom's sliftwoo: 110D "ally km a hamad i"tifift" ;%j* .—co� ot� �& .t Tme or wolito olion pw"" 0i Vs----I ("4)3474W 4kP P R 0 v e D CITY OF ATLANTIC 9CACH BUILDINr MAY By: 05/12/2003 12:45 9047450000 ARL BCHS ROOFING PAGE 03 Florida fluildlag C044)Ac4ldsconowits for Amp 411 gMnfjlo AIIAcJq"aj CIIAPbr IS RdegAsewntibee inaRceft;fil,eju go 0j#,,,,200I FI.We 8Wdkv Coda jr SMI"od*aa v Avadlymam mom of SKIM nor.,,= 0 balm 110 wort.4 naft per gbrip WjhVq we faQl#irbd. go High�Fbk%*I*M*4" 0Ab`"14)*W and&O"M C'JrO"&*)r In WhMJMln 1IDMohw9&9dw. owr4w d nbk NO,*am mad 66 pm@ fWW^STM 03,$1 (Fmft"10 110 nWh)CW%M�DC PA 107,96,or an mq,*gd by Ow onsWacitw,4,= I "04 ant ao"Plabill for too in the*Atm stow In aw Wft ba-0,MUIN 116 mud Pmkm Q&I M;,, I S#t*n'518,7 M44M Ork to a*Ifigh VWwjj KmIlme ZOO(MWO-Oade and Orowad r.awatO ony)and @Uk%e VW IM sMn Must tO Iftelog"in w*the Rod—'ow*ol mmovel,w 115 ftmd no Ian own a MPP ion 1514.F-3 2jl.NOTE:jnm6M;4)0d8 and eov.,Wj -vd rmAnt 46JU as'other Opp. kfam"dawam(me am" MIWG or f"anwa --4*6-*-6 a8ft Par IMP kWIVO MUN I be u"o Igian#a GM%M hm 10914111 M,0C PAIW vAh bww TN6 14"*"PrQW@d by ARMA to skimWao jalft mmdu&,d by ARMA warntmrs on IN k pro"a W so lhabb 0 ak"OTAN Abc0*419 of doe Fiamme EkWnq Co" md joaft W043MM VAO 00 19 11w AR14A veh"-wwwA0pW"&j#V,_q_ckj on tftr to dowbad -A"W Mkvwo mcabay anIt—ba Fk"I-" 1114b"lon d the florift RoAV,ShaNdidbw At,C-I HM-Mg C-*-n Aonck*m fFFAL84). 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REIUP.N D00k 11046 PHONE 744-asa8. 1383 Ncmcic or PERMTT # P"A No. so"or FI-Q&TnA Tax lsolo No. CWJ*of To WhOM It raw concem: The UMd"gnad hereby lnloftns YOU*W&mPWVQMnft vrW be nude 10 01110M real PMnrty.and In 4"Onliftricil Wlth SMWon 713 of the Flod&Stojfes.the f6bowift Infonr4#0n 14: 1 It commomcmeff. In%is Nam Op L"Wd"-PU0nQfWWftbiWQWWWmd: -=0M, Adorm Of Mmly bWV imprwood: RE-ROOF Owner Address 0 Owners hil"M in MW of the IMProvemmord FOG SknPl9Tld*l0ld6r(tF0thWt*num* N/A Narm MIA Address— VA contreaw ARLINGToti -BEACHES ROOFItIG. INC. Address- I&&I rg-qrRy Tggg&Cg 9ACA MR. DA 32211 Phoft No. 744-1888 FaxNo. 745-0000 sur"(N w4- N LA Addram-m 14 - ofto id 4 N/A PhwW NO.- N/A FIX No.Xla� NOM SiMaddrism of wW person mlift a ken for to mWnWMM of"MWovemW te, Nam-- NY& Addreas K/A PhOft No. N/A Fax No. N/A Num d Mork wOm the Stab of FWW&,vow lm hirlsof.desioneled by ownet whom noWn or otm dOm~tx May be sefted: NWft-- tj/A Address NIA Phnne No. N/A FmxNo. N/A in addition to hirv"f.owrw designmes#W folowing person lo i a m h m a cW&to Lk We Nud"pa,pvvidod in Samon 713.05(2)(b).FlorMs SWWW.(FM In at OwWs oprion), Ns= N/A Address x/A Phoft No. 111A FaX No. N/A ExPirshon deft of Nobom of Commencomera(10 441radon dab Is am(1)Yeef*Vm 6 o dft of moprft Unless a Mkmt daft is spealledy 11/A iW spAcr,AbA RIC-CMDERV USE ONLY Before me V".Z.AL ft Of- MjW Ig 10%341LO66 4 1 Courity of Dwal,Stab of FWAWlb @ppWW R I W I rawp3m lerw 01150,54 PM CLUX ClWm MRT Notary ft"o at Large,BUft d of WK.cKWry expir". Pw"n*Ny Known or Prodiced IderMostion 05/12/2003 12:45 9047450000 ARL 8CHS ROOFING PAGE 01 FJLX COVER APJ41NGTOR BRACKES ROOrING 1441 CBSICRy TWtRACZ JACKSONVILLE,, plooRIDA 32211 DATE TIRE: TO: FRO14: PWMz: (904) 744-8088 10 PAX #:(904)——0000 74S RE: Ir TOTAL NUMBER OF PAGES IINCLUDING COVER ETTER) : NOTE: IF YOU DO NOT RECEIVE ALL PAGESp BASE CONTACT US AS SOON AS POSSIBLE. L . CtfrY OF ATLANTIC BEACH PERMIT . CALCULATION- SREET Address Date Heated Square Footage 3:1 e r sq f t ..= Ga rag e,�Sh.ed -Mer .sq ft Carport/parch sq ft .= Deck @ er sq ft Patio e r sq ft TOTAL VALUATION: .Total Valuation ist Remaining Value P�' P e r t ho is and or ..partion t ereof TOTAL BunbuG FEE + 1/2 Filing Fee $ F-i rep I a.c �s $1 S . 0 0, BUILDING PERAIT FEE $ WATER IMPACT FEE SEWER IMPACT FEE WATER* METER/91AP CAPITAL IMPROVEMENT ..SEWER TAP -RADON . (HRS) . 005Q SECTION H PAVING HYDRAULIC SH RES CROSS CONNEC ION+ $ SURCH GE .005o OTHER -GRAND TOTAL DUE 7s ADDITIONAL PERMITS OR FEES : _Plunibiag Electric/New Electric/Temp______J;Swimmirlgpool Septic Tank well sign Finish Floor Elevati.on Survey ; ,Other CAL and/or NOTES : PREPARED 5/29/03, 17:46:50 INSPECTION TICKET PAGE 7 CITY OF ATLANTIC BEACH INSPECTOR: LARRY J HIGGINS DATE 5/30/03 ------------------------------------------------------------------------------------------------ ADDRESS . : 705 SABALO DR SUBDIV: TENANT, NBR: RRROOF CONTRACTOR ARLINGTON BEACHES ROOFING PHONE (904) 744-8888 OWNER CAMPOS, ANN MARINA PHONE PARCEL 171297-0000- - APPL NUMBER: 03-00026039 ROOF ------- ---- -- ---- ------ PIRNIT: ROOF 00 ROOF PRIXIT ----------------------------------------------- REQUESTED INSP DESCRIPTION TYP/SQ COMPLETED RESULT RESULTSICOMMENTS ------------------------------------------- ---------------------------------------------------- 17 01 5/28/03 LJH BD SHEATH G T E: 13:00 5/28/03 AP 16 01 5/30/03 LJH ------------------------------------- Co COMMENTS A D NOTES -------------------------------------- C (f ;> CITY OF ATLANTIC BEACH 611 800 SEM[NOLE ROAD -5445 ATLAIMC BEACH,FLORIDA 32233 TELFyHONF,:(904)247-5800 FAM(904)247-5805 SUNCOM:852-5800 —fA L/ http://ci.atiantic-beach.fl.us r 41 PLAN REVIi OMMENTS Permit Application Applicant: Address:--I Project: o y applicati6n is approved :dUr /Your permit application has been reviewed a nd the following items need attention: Z5,T= tk AD CIr-—L 47 .......... TU Please re-submit your application when these item;have been completed. Reviewed by---- Date Signed__________ Contractor Notified Date &0 CITY OF 4dantz BewA-&;&I d* 4 Office of Building Official REQUEST FOR INSPECTI:N� Permit No. Date Time A.M. Received -,PM: 170 5 Locality Job Ard ,2_ Owner's Name or BING PLUME31NG MECHANI�� BUILDING CONCRETE ,-- n"r-,-r�,, D Framing El Footing El Rough Wiring D Rough Ll� Re Roofing El Slab El Temp Pole [] Top Out D Heating Insulation E Lintel El Final Fj Sewer E Fire Place Pre Fab READY FOR INSPECTION Mon. Tues. Wed. Thurs. Friday Inspection Made 4A. F�ial Inspe Inspector �io cu ancy El Ce i icate OKc L,� Date ge, 4�F CITY OF SEMIN13LF-ROAD ATLANTIC BEACH, FLORIDA 32233-5445 TELEPHONE(904)247-5800 FAX(904)247-5805 SUNCOM 852-5800 DATE �5-- 3��) -00 JEA Construction & Maintenance 2325 Emerson Street Jacksonville, FL 32207 Attention: Connie Re: Final Electrical Inspect ns Dear Connie: Final Inspections on the following locations �ave been completed and approved: PERMIT NO. ADDRESS k:3 q 2- /9 5IS49-e�'- -",/ y 0j R Please call me at 904-247-5826 if you have �ny questions. Sincerely, x L ATLANTIC EACH BUILDING DEPARTMENT CITY OF ATIAM IC BEACH PMRMTT APPLXCATZON REMOrElf AMXTIONS, OR ALnMATIONS VING rEM,'; Own e r(s) MY FIL� Job Address: .26)-�g- \3Ael&4_0 pij,hone: 91,-/ ��2y t)—S-/ 9 e) Lot # Block or Unit # Subdivi ion: Contractor: State License # 7r-!!5- Z�b /D/51�o i t e N o: city State Zip Code Describe work to be done; Present use of building: Valuation of Proposed Construction: Propos-ed use: is this an addition? If yes, what are the dimensions of the added sp�ace ft. X ft. Will the added area be heated and cooled? New electrical (or increase) ? New plumbing fixtures? New fireplace? New Heat/AC? SLYMC.T TARNM (CMAMCIAL) TWO CCWZN= SWS OF PLANS, MCMDDING SX2r PLAN, SMM", ZMEWY COM -FMff' NOTXCE or 4� -----NT/ AND MWICOXTRACTCM AYrXn&VZ.T, Xr OWJMR zS CGMRACTM. Signature OWNER:- Date: A//P Signature CONTRACTOR: Date: AS TO OWNER: Sworn to and subscribed before me thi 2000. NOTARY PUBLIC AS TO CONTRACTOR: P&M*Amomft W CaMMMM 0 CC56M DORN August 27,2000 MOD rM Tpq 00 MSYR"E'IKI Sworn to and subscribed before me this day f NOTARY PUBLIC CITY OF 800 SEMINOLE ROAD ATLANTIC BEACH,FLORIDA 32233-5445 TELEPHONE(904)247-5800 FAX(904)247-5805 SLTNCOM 852-5800 CHAPTER 489, FLORIDA STATUTES, PART I "CONSTRUCTION CONTRACTING" REQUiRE:S OWNER/BUILDE:R TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489. 103(7). FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO 13E DONE BY LICEN ED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU, )S THE OWNER Or YOUR PROPERTY, TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOL MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE - OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR -Ess. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY Norr BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE: BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE, THE IAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU M NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILD NO CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. ORDINANCES ALSO ALLOW AN OWNER To impRovE THEIR C IWN PROPERTY WHEN IT IS FOR PERSONAL OR FAMILY USE, AND LIKEWISE REQUIRE ALL WORK (EXCEPT MAINTENANCE UNDE:? $2,000) BE UNDER A BUILDING PERMIT AND PASS ALL NORMAL INSPECTIONS. THE ORDINANCE STATES OWNERS MA- PHYSICALLY 00 WORK THEMSELVES; OR MAY HIR UNLICENSED WORKERS PROVIDED SUCH WORKERS BE UNDER "DIRI:CT SUPERVISION Or THE OWNER, WHO MUST BE ON THE JOB AT ALL 77M WHILE WORK IS IN PROGRESS BY UNLICENSED TRADES PEOPLE." THIS DOES NOT ALLOW USE OF UNLICENSED CONTRACTORS. SINCE: OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED UNDER THE HOMEOWNERS INSURANCE POLICY CLEARLY PROTECTS THE OWNER. OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON I HEIR IMPROVEMENT TRADES. UNLICENSED CONTRACTORS CA14NOT BE EMPLOYED UND R ANY CIRCUMSTANCES. OWNERS BEING SUBJECT To $5,000 PENALTY UNDER FLORIDA STATUTE No. 455-228(l). AN-"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE: OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRAC70R. TELEPHONE THE BUILDING DEPARTMENT (247- 5826) IF IN DOUBT. I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE!SrATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. PRO�tRWJQW-�&R/BU I LDERi ADDRESS TELEPHONE SWORN TO AND SUBSCRIBED BEFORE ME THIS _�.�� AY O-� NOTARY P4BLIC W comfAssj()P,,w NOTE: PHRASES UNDERLINED ABOVE MY COMMI�SION EXPIRES: hi. m ARE EMPHASIZED BY THE BUILDING emo THM TROY�;IN JNSUMW� DEPARTMENT. CITY OF ATLANTIC BEACH DEPARTMENT OF BUILDING 800 SEMINOLE ROAD-ATLANTIC BEACH,Ft.-32733-TEL-. 247-58265-FAX: 247-5B77 PERMIT INFORMATION LOCATION INFORMATION Addr-es-s--:----7--0-5-----S---AB-A--L-0--D,RIVE --- Permit Type- REMODELING ATLANTIC BEACH, FL 32233 Class of Work: REPAIR I Township: Range: Book: Proposed Use: SINGLE FAMILY Lot(i): Block- Section: Square Feet: Subc ivision: ROYALPALMS Est.Value, Parc D) Number: Improv. Cost: 1,000.00 Ow NER INFO R-MATPON Date Issued: 8121/2000 ----wa me: CAMPOS -- Address: 705 SABALO DRIVE Total Fees: 30.00 Amount Paid: 30.00 ATLANTIC BEACH, FL 32233 Date Paid: 8/21/2000 Phone: (000)000-0000 Work Desc: REPLACE ROMED-WO-OD; MISC. REPX0,11� CONfR--A6T-rQORA--S--- APPLICATION FEES PA-0PERTY 6WNEW— ----30.-00 Inspectio"A Requinod J NOTICE- INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPAC- , MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER E AND "FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS" ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OFTHIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. TI&S17 --Clwi�IiUl DING�DjE . I on CY I I CITY OF ATLANTIC BEACH DEPARTMENT OF BUILDING '800 Seminole Road -Atlantic Beach, FL 3223$-Tel: 247-5826- Fax: 247-5877 ELECTRICAL P E ERMIT LOCAM-k Permit Number: 19977 Adi Iress: 705 SABALO DRIVE Permit Type: ELECTRICAL ATLANTIC BEACH, FIL 32233 Class of Work: INCREASE T nship: Range: Book: of; Proposed Use: SINGLE FAMILY Lo s): Block: Section: Square Feet: S'u division: ROYALPALMS Est. Value: Pa cell Number: Improv. Cost: V"Ift -010"" T Date Issued: 5/01/2000 ll�iame: CAMPOS Total Fees: 30.00 Address: 705 SABALO DRIVE Amount Paid: 30.00 ATLANTIC BEACH, FL 32233 Date Paid: 5/01/2000 Pione: (000)000-0000 Work Desc: ESS100AMPS-150AMPS 1 PH 3W 240V AL JM SERVICE INCREASE AND AC wb"W MORRIS, JESSE ELECTRIC PERP 1IT 30.00 &L -:4 ow 'Pool FINAL NOTICE - INSPECTIONS MUST BE REQUESTED AT I-EAST 24 HOURS PRIOR TO INSPECTION BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTF ACTOR OR OWNER "FAILURL TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IM PROVEMENTS" ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. ATLANTIC REACH BULLDING DEPT. LEASF ACTE-PENAUTT This lease agreement is executed this d ty of September, 1998 between the Fly's Tie Irish Pub, 77 Sailfish Dr. Atlantic BeacAL 32233 and Fulton Fish Market, Inc., 85 Sailfish Dr. Atlantic Beach, FL 32233. The term of this lease to run currently wit lease at 85 Sailfish Dr. Atlantic Beach, FL with Fulton Fish agreeing to the following co. ditions: 190 ��e space required to build freezer is 15 x 20 eet and the rent will be $ per u =on year. 7Y- 2) Fulton Fish agrees to provide Liability Insurance at their own expense. 3) Fulton Fish will build concrete slab for freezer and will remove slab at the end of the lease (if required by landlord) at its own expense. 4) Fulton Fish will fence completed freezer at its )wn expense. In witness wherof, this lease has been duly executed by the parties hereto, as of the day and year first written above. Signed, sealed, and delivered The Fly's I&Aish P b in the presence of- Ian ord Fu 6 tenant Oc( 14jdv 2 7 2 L! 0 CitY c f Ada"I'Lic Beach BL!`Idin�� and 7 -orling CITY OF ATLANTIC BEACH, FLORIDA Approv*d by APPLICATION FOR ELE�TRICAL PERMIT TO THE CHIEF ELECTRICAL INSPECTOR: DATE:-7�/'� IMP013TANT NOTICE: IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE WORK AS DESCRIBED IN THE FOLLOWING, WE HERE13Y AGREE TO PERFORM SAID WORK IN ACCORDANCE VYITH THE ATTACHED PLANS AND SPECIFICATIONS, WHICH ARE A PART HEREOF, AND IN ACCORDANCE WITH THE ELECTRICAL REGULATIONS, CODES AND CITY OF ATLANTIC BEACH ORDINANCES. o n6 ELECTRICAL FIRM: MASTER ELECTRICIANE IGNATURE JOURNEYMAN NAME (?,4 ADDRESS:--� RFD—BOX— BLDG SIZE B ETWEENf�ifj'4 Okl E I- RES-0(z" APT. ( comm. ( PUBLIC INDUI I NEW( ) OLDo< REW. ( ADDITION ) TRAILER TEMP. ( ) SIGNS ( )-- SQ. FT. SERVICE: N71 INCREASEV-�, REPAIR I — FEE CONDUCTOR SIZE AMPS /-50 COPPER ALUM.�x SWITCH Oij�� 150 AMPS PH3W O�'dl(-�?40LT RACEWAY I ---------------j -3 EXIST.SERV.SIZE /00 AMPS PH Wjy,c)VOLT RACEWAY FEEDERS NO. SIZE INO. SIZE I NO. SIZE LIGHTING OUTLETS CONCEALED OPEN TOTAL RECEPTACLES CONCEALED OPEN TOTAL 0.30 AMP SWITCHES INCANDESCENT FLUORESCENT&M.V. FIXED 0.100 AMPS. OVER APPLIANCES i -1 1 BELL TRANSF. AIR H.P. RATING H.P. RATING CONDITIONING COMP.MOTOR OTHER MOTORS A PS ICEIL HEAT: KW-HE4T cq l/ 0-1 OVER MOTORS H.P. VOLTAGE PHS No. I H.P. VOLTAGE PHS MISCELLANEOUS 04 44U U 7!l,e ret iir-r -1 -r TRANSFORMERS: UNDER 600 V. OVE R 600 V. NO. KVA I NO. lKVA N EACH 0 MA. OTO SIZE SWITCH FLASHER 0.NEON TRANSF. VA. SIGN FORWARDED $ TOTAL FE A mrrse- A^f i —PARTI-VIENT OF BUILDING ELECTRICAL PERMIT LUI-AIIUN INFORMATION Per. R Number- -I AddreSs- ATLANTiC; BEACH, FL 322,33 f C I a s s o 1ANVIO swil.. I ouir-ar wain Rmncm� r% r U-1 Use. SiNGLE FAMILY Lotts)� Block: Section: minn, K I PAI Tv!S ware Fet Est. Va I ue: Parce Number: un-turov. a m-m-w�r, qu- i-r sim D -e Issue-1: 51nj ioonn at I U Nan GA N11 P 0 S Tx%tag_ Paaa= ttf! A a4A— n R Q A n n- .-.p v. Amount Paid: 30.00 ATLANTIC BEArw 1=1 -499-4-4 R F C, -I ri%A a fir-1c, AnLj ','A i --.A^0 1 A i I r'- g--.— 36 1 jo,r-1 a C'r- A�6..M A CONTRACTORIS% APPLICIATION FEES, Inf-mr-minnn Rarim M! 1� CD A�[7 ANIF1 N4UST BE '_'LEARED UP AND HAULED AWAY BY EITHER C.O�JTP ('FOR OR OWNER A-1 "FAILURE Tr- 9"*f-.R20: Y 1-1-11-1714 THE r-0NSTRtjL-TlL- 1-- rV.*32 f IN 11=14 LA W CANJI OPRI H T I%- PROPERTY .-�%ASJL UvOir-K PJAVINij lvvl%�= rwr% dUR_1jH,%%J A r%�r�A �4 flf— r�r-r-IRAVV A ki�. C-11 iSSUED A(X00RUJING TO APPROVE-LD rPL11-%Vq;_1 Vvrllurl/Ar"L: 1'fArl�I Q r-f-f-mvi 0 ell"a" QVLJ I t ,FOCR V1'01_AT'r%'-' nc A Do' ICA 81 E DD-0 ISIONS 0C. A-A.' Date: 5/01/09 R Receipt: 053691, CHECKS BUILDING AND ZONING INSPECTION DIVISION CITY OF ATLANTIC BEACH ATLANTIC BEACH, FLORMA 32233 APPLICATION FOR MECHANICAL PERMIT CALL-IN NUMBER IMPORTANT — Applicant to complete al items in sections 1, 11, 111. and IV. 6 /&�7 A Street Address: LOCATION OF Intersecting Streets: Between And Rai'l P_,6h nl-. BUILDING 0316 t ar, Sub-d;vision7"Odl A�rn- 11. IDENTIFICATION — To be completed by all applicants In consideration of permit given for doing the work as described in the abose statement we hereby agree to perform said work in accordance with the attachLed plans and spec;ficafions which are a part hereof and in Acordance with the City of Jacksonville ordinances and standards of good practice listed fherein. Name of Mechanical Costradors Contractor (Print) Me Jor �Ica n VW fin Ft j EJ Q)'I -Trr, Name of Property Owner -leg Signature of O;n er Signature of or Author. d Ar6ifect or Engineer M. GENERAL INFORMATIO14 A, Type of hoofing fuol: B. IS OTHER CONSTRUCTION BEING DONE ON E] Electric THIS BUILDING OR SITE? nC) Gas—0 LP [3 Natural [I Central Utility IF YES, GIVE NUMBER OF CONSTRUCTION Oil PERMIT [3 Other — Specify IV. MICHANtCAL EQUIPMENT TO It INSTALLED NATURE OF WORK (Provide complete list of components on back of this form) FWRl,ide,tial , El Commercial Go"' Heat [3 Space Cl Rocessed ar"Confrol 0 Floor El New Building EYI�Ir Conditioning: 0 Room 133,"Confrol 1 E&4"'Existing Building • Duct, System: Material Thicknoss— LA+"'Replacement of existing system Maximum capacity c.f.m. 0 New Installation(No system previously Installed) • Refrigeration El Extension or add-on to existing system • Cooling towor: Capacity 9-ll El Other — Specify • Fine sprinll Number of head- • Elevator 0 Monlift 0 Escalate, (number) THIS $PACE 0OR OFFICE USE 01,4Ly E3 Gasoline pumps (number) (Racell 0 Tonk, Inumbeir) Komor6 0 LPG containar (numbor) [3 Unfired pressure vesset 0 Boilers lPerm;i Approved Data— b Other — Specify �ormit Fare I LIST ALL EQUIPMENT AIR CONDITIONING AND REFRIGERATION EQUIPMENT CVWtY A rovftr Number Units Description Model Number Manufacturer (TO11111111) 12- HEA77NG - FURNACES, BOILERS, FIREPLACES Capacity AW.ovft Number UnlU DeecrtpUon Model Number I Manufacturer MM) AS.MW 12)a8 V oln rc f�Q'Ono TANKS Now Many Nowin" capacity TM UqUid Name of Serial Approving and Dimensions Contained Manuft turer No. Agency CITY OF ATLANTIC BEACH MECH),%NRCAL rPERIP01 I-T, wn r-p*-.101 A71—P471C BEAD T-' K-2-13'--TF-'--- ;�4477--IR26;-FXX: 22447 M PERNITWFORM-ATION LOCATION INFORMATION Permit Number: 20034 -Addriss-: P + -y erm! T pe- MECHANICAL -ATLANITIC BEAC-Hf� FR- 3,1-233 Class of Work: ALTERATION Township: Range: Book: Proposed Use: SINGLE FAMILY Lot(f 1: Block: Section: Square Feet: Subc Nision: ROYALPALMS Est.Value: Parc 0 Number: improv. cost: OWNER INFORMATION-- Date Issued: 51109il--000 Na-ne: CAMPOS Total Fees: 37.00 Addr?ss: 705 SABALO DRIVE Amount Paid: 37.00 AT LANTIC BEACH, FL 32233 Date Paid: 5/09/2000 Ph4 one: (000)000-0000 Work Desc: REPLACE CONOENSER AND AIR H I AN-DLEF CONTRACTOR(S) APPLICATION FEES I JOAN EVANS FUEL OIL, INC. 37.00 Inspec ions Required FINAL NOTICE-INSPECTIONS MUST BE REQUESTED AT LE ST 24 HOURS PRIOR TO INSPECTION BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK FAUST NOT BE PLACED IN PUBLIC SPACE, AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRA:3TOR OR OWNER ULT "FAILURE TO COMPLY WITH THE CONSTRUCTION I-I N LAW CAN RESIJ IN I HE "'ROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS" ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART Or'THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PRO-VISIONS OF LAW. $37.00 1A Date: 5/09/00 01 Receipt: 09550A ATL26 B-CEACA BUIL D PT. CASH 0@100083221000 CITY OF ATLANTIC BEACH 800 SENHNOLE ROAD ATLANTIC BEACH,FL 32233 SPECTION PHONE LINE 247-5826 Application Number . . . . . 06-00034373 Date 12/06/06 Property Address . . . . . . 705 EABALO DR Application type description RESIEENTIAL ADD/RENOVATE/ALTER Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 1125 ----------------------------------------- -------------- -------------------- Application desc REMODEL/REPAIR ---------------------------------------- ----------------------------------- Owner Contractor ------------------------- ------------------------ CAMPOS OWNER 705 SABALO DRIVE ATLANTIC BFACH FL 32233 ATLANTIC BEACH FL 32233 ----------------------------------------4----------------------------------- Permit . . . . . . BUILDING PERMI Additional desc Permit Fee . . . . 40 . 00 Plan Check Fee 20 .00 Issue Date . . . . Valuation . . . . 1125 Expiration Date . . 6/04/07 ---------------------------------------- ----------------------------------- Fee summary Charged P*id Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 40 . 00 �40 . 00 . 00 .. 00 Plan Check Total 20 . 00 20 . 00 . 00 . 00 Grand Total 60 . 00 60 . 00 . 00 . 00 PERA11rr IS APPROVED ONLY IN ACCORDANCE W171711 ALL CrFY OF Al LAN17IC BEACH ORDINANCES AND THE FWRIDA BUIULDING CODES. CITY OF ATLANTIC BEACH PLAN REVIEW SHEET D..Hufeetetler Building Department Public Works Public Utilities Departments ro rr 9 800 Seminole Road 1200 Sandpipc-Lane R.Carper Atlantic Beach,Florida 32233 Atlantic Beaeb Florida 32233 D. Kaluzniak (904)247-5800 (904)247-583— Public Safety (904)247-5845 Fax (904)247-584' Fax PLAN REVIEW COMMENTS Permit Application# L16 - zk3 Property Address S-*&zc Applicant: Project: '�n is-v jdwes- - I This permit application has been: E;K�'Approved as noted by the Ai>gr Department. Final application approval musk come from the Building Department. Reviewed and the following itei as need attention: Please re-submit 2-copies of all revisions. Please re-submit your revisions to the Department requesting them. Building Dept, Public Works and Utilitly information at top of page, failure to notify the correct department may delay your permit from being issued. Reviewed By: Date: 141WI-06 Date Contractor Notified: 00 r�ANTIC 13EACH CITY OF A T-A- BUILDING PERMI PPLICATION (New Resi I & Commercial) -01119 pl�I` �( it� Date: eZ., ^4 A.)7-V- Ic Job Address: a Owner's Name: UAG- Address: f3:3-7 oVft6e&)0W,6 Phone: 3 ri�-377F' Contractor: State License Number: Address: Phone: city: State: zi.): Fax: Describe proposed use and work to be done: /11v/z. Present use of land or building(s): Valuation of proposed construction: 4//v7 5--(TO Is approval of Homeowner's Association or other private entity required? Me If yes,please submit with this Application. Will this project involve changes in elevation,site grade or any u of fill material, addition of 5% or more to the original imp u area? 0 Applicant certifies that no change in site grade� impervious area or fill material will be used on this project. YES. Approval of the Public Works Department i eq�. ed prior to issuance of a Building s r Irl , t 100 Sandpi$er Lane,A-B,Telephone#is (904)249- Permit. The Public Works Department is loca e at 12 5834,Rick Carper,Director. PROCEDURE: IN ORDER TO EXPEDITE ISSUANCE OF PERMITS, IT IS RECOMMENDED THAT THE ARCHITECT OR CONTRACTOR OF RECORD COM PLETt THIS CHECKLIST, AS IT IS DETAILED AND TECHNICAL, AS WELL AS CONTAINS LATI-GUAGE SPECIFIC TO ADOPTED CODES. AN INCOMPLETE APPLICATION AND OMISSION OF INFORMATION WILL CAUSE A DELAY IN THE ISSUANCE OF PERMITS. T- VERIFY ZONING DESIGNATION AND PROPER SETBACKS FOR THE PROPOSED CONSTRUCTION.IF YOU ARE UNSURE OF THIS INFORMATION,PLEASE CONTACT THE P1 ANNING AND ZONING DEPARTMENT AT 904-247-5826. PLEASE READ ALL INS TR UCTIONS, WITHO UT THE INFORKA TION REQ UES TED THE APPLICATION WILL BERET WITHOUTREVIEW BUILDING CONSIRUCTION PLANS 5 SETS OF PLANS STEP 1. PROVIDE STATEMENT OF COMPLIANCE (IN ALL PLANS TO READ SUBSTANTIALLY AS FOLLOWS: "THESE PLANS WERE PREPARED AND SHALL COMPLY WITH THE FOLLOWING: 2004 EDITION FLORIDA BU114DING CODE,BU[LDING,PLUMBING,MECHANICAL,ELECTRIC." 800 Seminole Road Atlantic each,Florida 32233-5445 Phone: (904)247-5826 Fax: (9 4)247-5845 - http://www.coab.us Page 2 Revised 10/06 K.ANY OTHER DOCUMENT REQUESTED BY THE]WILDING AND PLANNING DEPT. PUBLIC WORKS AND PUBLIC UTILITIES.FBC 5$3.79. Address and contact information of person to receive all correspondence regarding this application (please print). Name: k 0 e-IIA001914— Mailing Ldress- nA I I Telephone: Fax: E-Mail: I hereby certify that I have read and examined this application and attached documentation and know the same to be true and correct. All provisions of the 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 federal,state or local rules,regulations,ordinances,or laws in any manner,including the governing of construction or the performance of onstruction of the property. I understand that the issuance of this permit is contingent upon the above information being true and correct and th the plans and supporting data have been or shall be provided as required. 10 Signature of Owne . Date: AS TO OWNER- Sworn to and subscribed before me this L1710 day of Ae *4 206 State of Florida,County of Duval SWAV L.OW—ft—ft Notary's Signat�re: Nowy Pubk-S"of F4ft Wy Cwaftsion EXVPkft FAA U. F� Personally 1�nown 20 Commi3sion#DD 5i8M Bonded BY National Notary Assn. F�`Produced idIentificatiort V, Type of ide�tification produced Signature of Contractor: Date: AS TO CONTRACTOR: Sworn to and subscribed before me this day o 920 day of State of Florida,County of Duval F�7Pes 0 s Signattre: rs ly 0 \1W rsonally]mown F1 Produced k entification �tion Type of ide itification produced 80OSeminoleRoad -Atlantic each,Florida 32233-5445 Phone: (904)247-5826 - Fax: (90 247-5845 - http://www.coab.us Page 4 Revised 10/06 December 04, 2006 To: City of Atlantic Beach From: Manuel F Campos 8337 Hedgewood Ave. Jacksonville, Florida 32216 904-384-3888 1,Manuel F. Campos am requesting a permit to repwr i he damage to my house at 705 Sabalo,Atlantic Beach, incurred during an Atlantic Bea,-,h Police Department investigation. Electricity and water will be restored under my name s week. Repairs as follows: Replace 3 front windows-37"x53" Double Insulated V 70.00 each $510.00 Total American Craftsman Series 211 0,FBC#3914.1,Miami-Dade NOA 03.0630.03. DP+501-50. Wind load 140 or less. Replace 2 side windows-37"x38" Double Insulated $150.00 each $300.00 Total American Craftsman Series 2110, FBC#3914.1,Miam i-Dade NOA 03.0630.06. DP+501-50. Wind load 140 or less. Replace I six panel interior pre-hung door $150.00 each $150.00 Total Replace I load bearing 4lx4x I O'PT with double post chors $150.00 Total Replace 13/411 PVC hose bib above cut-off valve 115-00 Total Expenditure for repairs $1125.00 Total Mantel F. ampos C�wner Ilate FILE COPY Special Information for(�wnerffluilders DISCLOSURE STATEN4ENT for Section 489.103(7),Plorida Stabites: STATE LAW REQUIRES CONSTRUCTION TO BE BONE BY LICENSED CONTRACTORS. YOU HAVE"PLIED FOR A PERM[T UNDER AN EXEMPnON To THE LAW The exemption allows you as the owner ofyour property,to act a s your own contractor even through you do not have a license. You must mMgrKjN the wasguction yggrself You may build or improve a one-family or two-fiumly residence or a farm outbuilding. You may also build or improw�a commercial building at a cost of$25,000 or less. The building must be for yoz own use and occupancy. It may n)t be built for sale or lease. Ifyou sell or lease more than one building you have built yourselfwithin one(1) t1hue construction is complete,the law will presume viol Yffexe fton. that you built it for sale or lease,which is a ation of t] You may not hire an un-licensed as ykur contractor Your construction must be done according"to building codes and zoning regulations. It is your responsibility to make sure that the people empl9ygd you relicenses required by state law and by qqgnty or ,Mu_m-Lc_ipql_licensing ordinances In addition,the owner must supervise construction and becomes habl,-and responsible for the employees helshe hum. Tins responsibility includes,but may not be limited to: I. Workers Compensation,for workers injured on job. 2. Social Security Tax must be deducted from employee's wages and matched with owner's funds. 3. Federal W-ithholding. Since owners must be liable for injuries to workers they hire,the uilding Division suggests Workers Compensation Insurance be purchased unless the homeowners insurance policy clearly protects the owner. Owners hiring workers become employers and should also observe MS withholding tax I orm 1099 requirements on the workers they employ on their improvement work. Un--licensed contractors cannot be=Loye A under gwy gmag*ces. Owners are subject to a$5,000 penalty under Florida Statute#455.288(l)instigated via Building Division citaflons. An QMMMfional License is not g4eqg@Lz. The owner should physically see the county Certificate of Competenq F or the Florida Contractors Certfficale to ascertain a person is a licensed contractor. Telephone the building Division (247-5'826'if in doubt- I hereby acknowledge that I have read and understand all the above on this Day of, 7ar zAo�-� D/ k)7,wr/c -4�e/A 0�vnei-Mfider Signat* Addms T(— z Print Name Telephone Number STATE OF FLORIDA: COUNTY OF DUVAL Before me personally appeared to me well known to be the individual and owner builder desc ribed in and who ex insti-tim and several y acknowledged the execution thereofto be his own fi= act and deed as such owner builder hereunto authorized. W MESS my hand and official seal this day of, aatAt . c Beac�-� f�idState aforesaid. 2c L- PP Pf Y P.L C.. A 0 NO BL C,'S pCIRIDA Print Name: Q na#" Noby Fv*. $"a 14 MY COMNMSION EXPIRES: A t4f" S,DDSis-M nally Kn a,.,)Z-7 - 80nded Bi Nafionw Am =enXcation: .5 Z&V