Permit 1902 Bath Remodel 1902 N Sherry Dr 2012 �}
ftz CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
.,. . ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00001541 Date 10/19/12
Property Address . . . . . . 1902 N SHERRY DR
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 12200
----------------------------------------------------------------------------
Application desc
bath remodel
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
PETERS, DONALD E WISE CHOICE PROPERTIES OF
1902 NORTH SHERRY DR JAX INC
ATLANTIC BEACH FL 322334520 1902 OCEAN DR S
JAX BEACH FL 32250
(904) 372-9024
-- Structure Information 000 000 BATH REMODEL
Occupancy Type . . . . . . RESIDENTIAL
--- ------------------------------------------------------------------------
Permit . . . . . . RESIDENTIAL ALT/OTHER
Additional desc . .
Permit Fee . . . . 115 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 12200
Expiration Date . . 4/17/13
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 115 . 00 115 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 119 . 00 119 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
NOTICE OF COMMENCEMENT
State of Tax Folio No.
County of 'wJo..
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 is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: 3-1 SIU %, Cil-2S -20%9 SC I✓a M 0.f i ne, U n i f No 10'L
Address of property being improved: 10102 he f f•a -D(-. A leld,- G Slaah ., FL 32-2-3.3
General description of improvements: 1�.�1hroo m ce r mtf
Owner: -Dovv-\.,A �-PtAddress: (Qp2 ;helfw fir. Ntff?o nhe Beew,h 32233
Owner's interest in site of the improvement: 166%
Fee Simple Titleholder(if other than owner):
Name:
Contractor: ,Naz --
Address: !34 pj % Avg. Si 1o►LKSon✓iI�t lel, �L 32250
Telephone No.: CIO.1-312-902,4 Fax No: �V to-S 20'3101 g
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: nek-
Address: 314 101 e s Sax Beo.eh , l=L 32.250
Telephone No: G10A4-312'9 02N Fax No: StnlD-S 20 - 3k t$
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: r�Qne� W y U
Address: 3'-i 101 j" Ave S. J&x 19�h. FL 3225D
Telephone No: CID - 312'Ll02q Fax No: 06ta -
Expiration date of Notice of Commencement(the expiration date is one(1)year from t e,, rQNRNgMWn differ t date is
specified): Commission#lil�EE 064252
r�•f„F,;;,:.,�,P� goaded Trou Trcy Fin Mxuante BI)0.3E5"T019
THIS SPACE FOR RECORDER'S USE ONLY OWNER
ff
Signed: G” rr Date.
Before me this day of in Co ty of D val,State
Of Florida,has personally appeared
Notary Public at Large,State of Fl9rtada,Cpun of Du,-4.
My commission expires: `
Personally Known: I or
Droduced Identification: rJ '"�
Doc#2012231982,OR BK 16111 Page 1924,
Number pages: 1 t Jjzkj-
Recorded 10j1912012 at 02:08 PM,
JIM FULLER CLERK CIRCUIT COURT DUVAL
COUNTY II
RECORDING$10.00
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH U � •
800 Seminole Road,Atlantic Beach, FL 32233 OCT
Office(904) 247-5826 Fax(904) 247-5845 91D12
Job Address: 1902 Sh oft;sa Tx, N pct vAiL3"A Permit Number:
No 10-c
Legal Description 311ft a °i-2S-20tC Selue. t�t'm ung+ Parcel#
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ 12.200 Proposed Work heated/cooled 24�_ non-heated/cooled 3l T
Class of Work(circle one): New Additio Alteratio Repair Move Demolition pool/spa window/door
Use of existing/proosed structure(s) circle one): Commercial �Resi
If an existing structure,is a fire sprinkler system installed?(Circle one): Yes N/A
Florida Product Approval#
For multiple products use product approval form
DesDes ricin detail the type of work to be performed: a-imom Pe.�-0 d
PropeM onner Informatioa:
Name: �A'L D z
2�
Add es : ��0 2 N• G'pcj- Z��O- to���
City State d Zip 312-33 Phone I
E-Mail or Fax#(Optional)_ Q�. Z e f� n
ContracLor Information:
c
Company
!Name- C�?vl r �� Qualifying Agent: t
Address: ` City�xc► Sta Zip
Office Phone� ( 9n? Job Site/Contact Number qp y- 3'12,-9p24 Fax# w _
State Certification/Registration#rr� 145, 1 4-t"t s
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and
Address
Bonding Company Name and
Address
Mortgage,Lender Name and Address
Application';is hereby made to obtain a permit to do the work and installations as indicated. l cert that no work or installation has commenced 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
becomes null and void i�work is not commenced within six(6)months, or if construction or work is suspended or abandonedfor a period of six(6)months
at an time after work is commenced. 1 understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools,Furnaces,
Bollers,Heaters, Tanks and Air Conditioners,eta
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
ORDING YOUR NOTICE OF COMMENCEMENT.
INIV J.MCIWIIRC
[ Y ' mi d this aplication and know the same to be true and correct. All provisions of laws and ordinances governing
thi h her specve
ed herein or not. The granting of a permit does not pres o authority to violate or cancel the
pr 7 l law regulating construction o t
•""""'' JOSE ROMSOLA
p� Y P4el��i
Notary Public•State ofAT Florida
V' f -
i -• • My Comm.Explroe Apr 17.2015
Signature of Owner 'C f ure 0fr9�1t
Q - j
Print Name 0 E. / � �� (( t ame Q
Swo t and suktscr' me....4 .1._ p. ....-... ._. L�..fo Sworn and subscribed..hefnr:�m/e............................_....-......
ay ....__.._......____..___
Dof this 'Day of CJ i' _ Z
this
Notary Public Notary Public