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96 W 3rd St Voided shed permit 2013 BP251I03 CITY OF ATLANTIC BEACH 6/19/13 Application Tracking Individual Step Inquiry 09:40:04 Application . . . . . . . . 13 00002178 Address . . . . . . . . . . . 96 W 3RD ST Application type . . . . . . . SHED PERMIT Revision/Path/Step/Seq/Agency= A 01 00 PW PUBLIC WORKS Required step, approval code = Y AP APPROVED Date submitted, resulted . . = 2/20/13 2/28/13 Status code . . . . . . . . = DA DISAPPROVED Reviewed by = LS LISA SHOWMAN Org cmpl date, revised . . . : 3/01/13 3/01/13 Copies of plans . . . . . . = Comments Print Date Shed must be built off grade. Cannot fill in retention 2/28/13 area. 2/28/13 Bottom Press Enter to continue. F3=Exit F8=In/Out Status F12=Cancel F14=Action log inq �' r3 ry) i nS c tea( d- shy IS q s� A-ta�/V\A -�� �►� - ..ej I 1- City of Atlantic BeachAPPLICATION NUMBER Building DepartmentCr (To be assigned by the Building Department.) 800 Seminole Road 1 �r Atlantic Beach, Florida 32233-544 - �/ �� Phone(904)247-5826 Fax(90 47 5845 ���� moo;1� E-mail: building-dept@coab.us Date routed: 7-be 13 City web-site: http://www.coab.us APPLICATION REVIEW AND T ACKING FORM Property Address: 96 ✓ Department review required Yes No Applicant: 4�mwinistrator oni Project: X �� % ublic w ities Public Safety Fire Services Dep t Si* natureWay 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: BUILDING PLANNING &ZONING Reviewed by: ( Date: TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. PWOKS Comments: UBLI - PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: []Approved as revised. []Denied. Comments: Reviewed by: Date: Revised 07/27/10 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233i"�, Office (904) 247-5826 Fax (904) 247-5845 QZil H _ r9 h Wed �ebruary 1 01 9 �� Public Underwriters Job Address: �// Permit Num a �� Legal Description Parcel# 8 oor ea o q. t• q• Valuation of Work$ �d� d Proposed Work heated/cooled non-hea c2 0 013 Class of Work(circle one): New Addition Alteration Repair Move Demolition poo pa w'. o r Use of existing/proposed structure(s) (circle one): Commercial Residential Y If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A Florida Product Approval# For multiple products use product approva orm Describe in detail the type of work to be performed: ly�Q �X �QChol�d ZPrort r6 o4 12— Property a Owner Information::] j Name: a__ Address: City State Zip2 Phone 1" E-Mail or Fax#(Optional) Contractor Information: Company Name: Qualifying Agent: Address: City State Zip Office Phone Job Site/Contact Numbe Fax# State Certification/Registration# 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. I certify 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 work void f work is not of commenced understand that sepain six rate permits musor t be secuconstructred for Electrical Work,Plumbing, Sigion or work is suspended or ns,or aWells,Poeriod ols x urnaces,Boilers,months at tHeaters, 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 EE OBTAIN ARE RECORDING OiTR NOTICE OF CONSULT WITH YOUR LENDER OR AN ATTORNEY Iherebcert laws and nces overning type gfYwork w will be complied with whether spteci iethat I have read and examinehis dlherein or not.o The granting of to permit does cnot pt. lrprovisions rue and sumeto give authority for violategor cancel the provisions of any other federal,state, or local law regulating construction or the performance of construction. Xgnature of Ow A ASignature of Contractor Print Name Print Name ..................................... ............................................................................................ , �_ .cL ....... . ...0-... .......�..4 -...... Befor,, Before me 20 this . ay o 5200 this Day of 2t�" '•kap, Sri1RLEYL GRAHAM otaiy Public N �: _ lAy COMMISSION#DD 9,97760 Revised 10.24.12 EXPIRES:February 14,2014 flf °o`r Bonded Thru Notary Public Undernmters I CITY OF ATLANTIC BEACH (OWNS / BUILD ER A ��A�T�I�' i .j I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAV. REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY.TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOUMAY BUILD ORIMPROVE 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 LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT 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 LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING 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. II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. M. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). 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 CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826) IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. . �z L/L ADD ESS PHONE NUMBER NT NAME iA S�<✓ DATE SI�NA RE V B` re me this�` day of 20 /_Ip the county of Duval,State of Florida,has personally appeared herin by h'lrhself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of L .County ofJ 0.Personally Known 0jPtoduced Identification- ; h�I Notary SiRnatirre. + uFF.Fl�ht ! F:BLDG/Owns-Buildri Afta&e it,REVISED: 16/2009,c'f "i>,l,'::'.1ir'_.,. '4.201,t ra ARM R, GIN > >xSE -i:m N m 2 �'C i `K� S ` `S E•��T Y t -o v v vii rn "rp Map rg 4ftD :" isl qr ;'ate orc ty v k£ C� 225 �_. ss �►- ff a _! K. a y Ln QT a SN zf2;u>c Ow �r. 4. z�rn N N t zxoy 8f Z> = mzva ..a.. _ ZD>mxZ a Q cN1-a� b� �jagn� a za m p G .�- u City of Atlantic Beach APPLICATION NUMBER Js � Building Department (To be assigned by the Building Department.) - 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845E-mail: building-dept@coab.us Date routed: �� City web-site: hftp://vmw.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: n" c a c J Department review required Ye No Applicant: anning &Zoni ministrator Project: X �� S// ublic w ities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B 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: BUILDING PLANNING &ZONING Reviewed by: Date: 2- 3 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 07/27/10 City of Atlantic Beach APPLICATION NUMBER js �ea Building Department (To be assigned by the Building Department.) r '` 800 Seminole Road /3 _ 7178 Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 x 4�; Date routed: 2 �d 13 E-mail: building-dept@coab.us City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 96 C3;,-C1 Department review required Yes No Applicant: 4anning &Zoni mir istrator Project: X �� � ublic W ities Public Safety Fire Services {� � #N` F Review fee $. De t Sig nature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B Florida Dept.of Environmental Protection Florida Dept. of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: proved. []Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by:_ 24A'Z.J'O Date: TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07/27/10 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 {ilk • ®' Office (904) 247-5826 Fax (904) 247-5845 .; :h ti0 /� //, / CT t•...• a to ebrua 1 01 9 W r c� / 4,F} nded ry Public Underwriters Job Address: Permit Num e � Legal DescriptionParcel# B Floor ea of Sq.Ft. Sq. Valuation of Work$ 49 Proposed Work heated/cooled non-hea c F 2 0 013 Class of Work(circle one): New Addition Alteration Repair Move Demolition poo pa w r Use of existing/proposed structure(s) (circle one): Commercial Residential Y If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A Florida Product Approval# For multiple products use product approva orm Describe in detail the type of work to be performed: Sll�A -71 dYl e rfTE lU1411 12- ,"n h-1 CAg45 Property Owner Information: Name: 5 G/ a, Address: / ..�. uw�.x�swuams�s City State ip 2 Phone E-Mail or Fax#(Optional) I ' Contractor Information: o� Company Name: Qualifying Agent: Address: City tare"=7TIF Office Phone Job Site/Contact Number State Certification/Registration# !VFED"FOR CODE CO- Architect Name&Phone# Fry OF AT Vff" Engineer's Name&Phone# 7,PER Fee Simple Title Holder Name and Address REQUIttm 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 i o wor or tnsta ation 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 ded or and work er void o wmenced.not commenced within I understand that separate permits muor st be secured for Electrical Work,Plumbing,Signs,or construction or work is suaWells P periodol',XFui acesmonth Boilers at s,tHeaters, 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.OR AN ATTORNEY BEFORE RECORDING YOUCONSULT H YOUR LENDER R NOTICE OF COMMENCEMENT. 1 her eb certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work wtll be complied with whether speci ted 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. knature of O Signature of Contractor Print Name . .-.. ..... Print Name ..................................... ............................................................................................ ...... Befor. Before me 20 this ay 120 La this Day of SHIRLEYL GRAHAM otary Public N IAY COMMISSION#DD 957760 Revised 10.24.12 EXPIRES:February 14,2014 ` Rf;�yq• Bonded Thry Notary public Underwriters - 7PY L CO I. (FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY.TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU 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 LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT 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 LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE. WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING 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. II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). 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 CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826) IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. ADDRESS PHONE NUMBER NT NAME DO SI RE DATE Before me this C day of Y �� 20 —1 the county of Duval,State of Florida,has personally appeared hedn by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of �L ,County of ❑Personally Known — ElPfbduced Identification-_��, / Notary S n.t re: GRAHAM - 1 *; "AY C(�ASM!^�lOY ri DC 95x7!0 k?IHES: F:BwnLDG/oBuilder Affad—it;REVISED: 16/2009 p %,RF I` � `�r.ndetl IRE ebrury 14.201 a I ow<� h o C wz=N57 cy eLQ=om 40 Z. 1414 _fir •`- tqY • tri eEAD � <t.. �Z <� L Jib, EL AT 86 4•r ?a—'��rIrJN � cb•� �- to �! C Vs �x_ Ril LL'JMoU +.� '�.. q' -• Yalta #i O� as ^ ` : � ��L s Qly�� �•�� "� E,L7� pdr `.W Lij�+ r,� ,. ��.. �� C � zz�= �t5S s ti ONCL On o off _ Ll 'w�rSeSwl.a�i0•lu�tit;tt,l6?i.:T..M i'LS i. y`�i'+, ��11y4i?91'R FILE COPYr n WC O E Q..—w C �NM+�+dM+1,NgR14i!c6 U U O (6 O O c0 � L _ a c a�io c�iwoE=:..-c� � m D c o•o � � CL TO=.o Ec 0 .w0 aN otOo � 02 lu C-) moU a> rni N�1•`h' 7 'O N U �l O � rn a> > o U c > o m u��vU.- c o o,- to CD m IL 0 oo� o�Gt m n E- c� >CL c c6 �o oLL am C >O ��✓ 0 > nt mm rov CL a F O to a-.§ a» U 7 - N-ota � Emm Q C.. .. CITY OF ATLANTIC BEACH ®MWiR / Bl DER d JIDAV T ,j 1, FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMTT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY.TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU 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 LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT 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 LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WHICH IS IN VIOLATTON OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REU1RED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. M. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). 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 CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826) IF IN DOUBT. V. D THE OVE RE STATEMENTLANDETMHAT � I HEREBY I COMPLY WITH ALL ACKNOWLEDGE ETHAT I HAVE EQUIREMEN SE FOR THEBIISSUANCE OF AN OWNER-BUILDER PERMIT. PHONE NUMBER / ADD ESS R NT NAMEW azo n Sl�#A RE DATE O aCb pp the county of V A O A B re me this day ofFe �� W Q Duval,State of Florida,has personally appeare ¢ A all statements and declarations are true and acc irate' IX ic�,� Notary Public at Large,State of ounty 2COPY O (�, ❑Personally Known E\ y� y(� O EJR duced Identification- • {�{ ,-} E ffrt Notary Signature: R A f y U F:BLDG/Owne_Builder Affadavix REVISED:�t/tsnoo9 ' '''•;,f, n ;�,