Permit Siding Repair 2109 Beach Ave 2012 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00001117 Date 9/20/12
Property Address . . . . . . 2109 BEACH AVE
Application type description SIDING PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
siding stucco repair
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Owner Contractor
------------------------ ------------------------
BLOCKER GEORGE C TRUST ET AL SHAYCORE ENTERPRISES INC
2109 BEACH AVE 10169 GENI HILL CIR
ATLANTIC BEACH FL 322335932 JACKSONVILLE FL 32225
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Permit . . . . . . SIDING PERMIT
Additional desc . .
Permit Fee . . . . 300 . 00 Plan Check Fee 150 . 00
Issue Date . . . . Valuation . . . . 50000
Expiration Date . . 3/19/13
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Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 NATIONAl ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 4 . 50
STATE DBPR SURCHARGE 4 . 50
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 300 . 00 300 . 00 . 00 . 00
Plan Check Total 150 . 00 150 . 00 . 00 . 00
Other Fee Total 9 . 00 9 . 00 . 00 . 00
Grand Total 459 . 00 459 . 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
FILE COPY ' 800 Seminole Road, Atlantic Beach, FL 32233
f" __ . -5845
FE Office (904) 247-5826 Fax (904) 247
AUG 9 ,7
V 1,/
Job Address: Z_I b 61 A-u-p- Permit Nu U/
%M4 3
Legal Description '13, Oct-25 -ZqF- -Sqo V tctv\'�' le"A Parcel#
;so coz) Floor Area of S q Sq*Ft
Valuation of Work$ 1 Proposed Work heated/cooled QW1 non-heated/cooled
Class of Work(circle one): New Addition Alteration QE�� Move Demolition pool/spa window/door
Use of existing/proposed structureQ) ��ircle one): Commercial I esidenti I
If an existing structure,is a fire sprinkler system installed? (Circle one): g0esg't(o N/A
Florida Product Approval#____
For multiple products use prod-uct approval form
Describe in detail the type of work to be performed: Qe-calc- 1,100-1 �vf oa\,, zs+ucco
'C>W f,�e I J<4-+76
4-1 D r- 9)I,\
Property Owner Information:
Name:OAr*ts Blocker Address: 2_1011� Ave-
City AAk nhr- ZkAcA� State1FL__Zip.12:2-S3 Phone. cj0Lj_,2,2.Lt - 1b2_2_
E-Mail or Fax# (Optional)
Contractor Information:
Company Name: 'o�x"Czot (�okqroie_5 lv)c-. Qualifying Agent: bavjc� MOAL
State Zip 32_24-�
Address:47-To fnb�c> PrJ C4 '5 zie LIZ> -City
Office Phone qo 4- IS-I- 2.57Q'2- Job Site/Contact Number qo 4- 2-2-1-11 t Fax# 1c)q-qrj2,-'4qi_
State Certification/Registration# CJ�->C 4) 3 -7-
Architect Name &Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
4pplication is he e ade a na e in to d he work and installations as i ndi cal or installation has commencedprior to the
1 11 r it 0 0 t e to in t the standards a I laws this jurisdiction. This permit becomes null
issuance t 0 o't p be e d 1 f s ixj6u) f
0 Per r by d ha k is sa
and void s k 9d q months at any time a ter
th , or Z 'truct'o or or Xellrsi Pools, urnaces,Boilers,Heaters,
n on n
e rin�ts" t sc, f
1 ''oe be red oroElectric,
(6
m t Iwo w p
k is not commenced w th s,
work is co" 'ced. I understand that separate p
Tanks andAir 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 FINANCING9 CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I here certify that I have read and exami.ned thi's plication and know the same to be true and correct. Allprovisionso awsiandor inan governing this
'sions o aws
,�dndtyordinanc ov
type 1�work will be ie with whether speciXed herein or not. The 7nting of a permit does not presumie to e aufhority to vio ate or cancel the
c grc
provisions of any oth,,7N �taV,��r loca, egulating construction or the pe�fbrmance of construction. /i
2
Signature of Owner(-", Signature of Contractor
," M
Print Name 0.—ker Print Name ................
�f ......................... D�m..................... ......................................
Sworn to and subscriped before me Sworn to and subscribed befpre me
this
-L't Day of Ao4,rhY 20 this 'X
�j_Day of 1,%+ 20 1Z
V
JW
Notary Public— Notary Pu BENJAMIN RIENDIF rlr
BOUANIN RENDFJW ommo v1s
MYCOWAOSIONOUI wo 0
EXPIRES FaINUMMW
0- 1117
NOTICE OF COMMENCEMENT
State of Folio No.
County of
FILE COP
To Whom It May Concern:
The undersigned hereby informs you that impr6 0 !*!bi*
-.-I- property, and in accordance with Section 713 of
the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved:IS- I S K)q --2-,5-z-ge sLic> o Ajto�n gecc",k Vjy� No. -3
Address of property being improved: 2J01 XJ-P- Aitayl-tl- 't�ex" , R.L, 2,1:2-
General description of improvements: -�41kcr-> aw-%;r V-)00.8 f-ai
Owner: ir 6cice r Address: '2ADcl -6e o_c,k Av e
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor:-Ska-4 Coce (�A4-erpr�se.S �vjc- -
e�AAddress: elt,6 t-D erb-D-, S S io'L" 'i S 2, 2,Lj
Telephone No.: %Lj S,5-1 2 -S�-c -2
I _ Fax No: qoq -q 12- I-lq I Z>
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name:
Address:
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:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one (1)year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNE
Signed-
nthis
fFlorida,has personally appeared
Before this da of k-J42yk- in the County of L5uval,State
Doc#20,12183726,OR BK 16048 Page 23, )tary Public at Large, State of Florida,County of Duval.
Number Pages:1 y commission expires:
Recorded 08127/2012 at 02:01 PM, rsonally Known: '�- ....... or
JIM FULLER CLERK CIRCUIT COURT DUVAL Dduced Identification: A BIENJAIRINF-WNDMU
COUNTY MYCOMMOSMSEE172M
RECORDING$10.00 EXMES FOmmy 21L 2016
City of Atlantic Beach APPLICATION NUMBER
A
0
Affik Building Departrnent (To be hp, m by the INAding Dspaknot)
SW Sen*x*Road �Z,2 - /// 7
Allende ,Flodde 322334445
Phone(904)247-5M - Fax(904)247-W45 EDale rouled: F12 7&1
E-nW. buldIrqkdept@coab.us
cily ma"ile! mlo-JAmm-embme
APPLICATION REVIEW AND TRACKING FORM
Property Address: 67� permnew re~required YASO, No
Appucant &Zoning
Tree AdministraW
Project Public Works
Public Utilfties
Public Safety
Fire Servkms
CWw Aaency Review or Permit Required Review or Rec@W Date
of Permit VerNled By
FlorWm DepL of Protection
Fkxide DepL of Transporbition
SL Johns Rmer Water Managernent Distrid
Army Coq)s of Engineers
Diftion of Hotels and ReWwwft
D101sion of Alwhok Beverages and Tobacoo
00mr
APPLICATION STATUS
Reviewft Departnteft First Re~.- B4mved. ElDenied.
(Cirde one.) Conwrionte:
PLANNING&ZONING Reviewed by: Date.*
TREE ADMIN. Second Review: [3Approved as revised. []Dikled.
PUBLIC WORKS Connuents:
PUBLIC UTILITIES
PuBuC SAFETY Reviewed by: Daft:—
FIRE SERVICES Third Review. []JApproved as revised. ODenied.
Conmnents:
Reviewed by: Date:
RaWsm!027HO