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85 Nicole Ln 2014 scend elclsure CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 Application Number . . . . . 14-00001207 Date 8/14/14 Property Address . . . . . . 85 NICOLE LN Application type description RESIDENTIAL ADDITION Property Zoning . . . . . . . RES GEN MF DISTRICT Application valuation . . . . 9600 ---------------------------------------------------------------------------- Application desc screen snclosure ---------------------------------------------------------------------------- Owner Contractor - ------------------------ ----------------------- BEIER, ALEXANDRA DAROS TROPICAL ENCLOSURES BY MASTER 85 NICOLE LANE SCREENS INC. ATLANTIC BEACH FL 32233 4411 KELNEPA DR JACKSONVILLE FL 32207 (904) 993-2256 --- Structure Information 000 000 SCREEN ENCLOSURE Construction Type . . . . . TYPE 5-B Occupancy Type . . . . . . RESIDENTIAL Flood Zone . . . . . . . . ZONE X ---------------------------------------------------------------------------- Permit . . . . . . RESIDENTIAL ADDITION Additional desc . . Permit Fee . . . . 100 . 00 Plan Check Fee 50 . 00 Issue Date . . . . Valuation . . . . 9600 Expiration Date . . 2/10/15 ------------------------------------------------------------------------ Special Notes and Comments 2010 FLORIDA BUILDING CODE, 2008 NATIONAL ELECTRIC CODE ----------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 ENG REV PRE APP > 3 HRS 25 . 00 STATE DBPR SURCHARGE 2 . 00 UTIL REV PRE APP >3 HRS 25 . 00 --------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 100 . 00 100 . 00 . 00 . 00 Plan Check Total 50 . 00 50 . 00 . 00 . 00 Other Fee Total 54 . 00 54 . 00 . 00 . 00 Grand Total 204 . 00 204 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. », ii u jii l,iiv v rhK1V11'1' APPLICA ION = - -- w CITY OF ATLANTIC BEAC.rI i800 Seminole Road, Atlantic Beach, F: 3223 FILE COPY ­ Office (904) 247-5826 Fax (904) 2,. -5845 Job Address: mit Number: Legal Description', Y-9 `t: t ;-4. -Floor Area o q.Ft. sq.Ft Valuation of Work $` Proposed World heated/cooled non-heated/cooled Class of Work(circle one): New <_ Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s) (circle one): Commercial `I$essiid_ential` .. If an existing structure,is a fire sprinkler system installed? (Circle one): Yes-rte N /A Florida Product Approval # For multiple products use product approva oro Describe in detail the type of work to be performed: Property Owner Information: Name: 1 itA Address: City i4 State(". €Zip may . Phone E-Mail or Fax# (Optional) f -t+�. L,T�:i,�C:.. i,c�vi --- Contractor Information: I Company Name:�oV"t�1&C16S A6e-5 6 , . 114as�S-c-,l "4v"QualifyinAgent-.g CtyAddress ,l State t�,•—, .- e Zip <, - Office Phone F'`t �a' Job Site/Contact Number 1 t Fax# �i f 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. 1 certify thct no work or installation has commenced prior to the issuance of a permit and that call work will be per formed to meet the standards of all lams regulating cot" uction irn this jurisdiction. This permit bec•onzes null and void if work is riot commenced within six(6)months, or if construction or work is suspended or aba,:Gioned for a period of six(6)months at anv time after work is commenced I understand that separate permits must be securedfor Electricalpffork, Plunihisg,Signs, K%!!s, Pools, Furnaces, Boilers, Heaters, 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. I hereby certifi)that 1 have read and examined this application and know the scone to be true and corr•ec; !provisions of laws and ordinances governing this hpe of n ork will be complied rnith whether s[�eci ied herein or• not. The granting of a permit does .- aeszune to give authorih to violate o cancel the provisions of any other federal,stale, or local lcrw regulating construction or the performance of construe: 'Signature of Owner V-am — Signature of Contractor:-->'1,= Print Name SZ tX' Print Name ........ ......... . ........ . .. ...... ......... ......_....... .................. Before me Before me this Day of 20 r `-` this Day o' � 20 Notary Pu[21i ,; Y• ; �KEWN1 kl,tA�;NP 1'-t SO E ;Pf dig!Vt;_.M f- 4EWSO4tE — c- 1`�.4.N fknY+:-:)iV1M!Sg10iN#EE108253 r;: My t.,. 3!0N#F 1082 u� ?: 1 2 vised 01.26.10 � a ., `Xr IR-7,it!ne 30,2015 ��'�,,�" .iCr iFc dune 30,%015 ; HOMEOWNER SUNROOM ENCLOSURE AFFIDA; FILE COPY 'I^ The purpose of this document is to make you aware of any limitations in the enclosure that is being permitted at your residence. The table below, Sunroom and Screen Enclosure Requirements provides a brief description of the various sunroom category requirements. There may be restrictions on the use of your present home depending on the category of sunroom you are installing. The property owner is hereby notified that should they make changes to the sunroom which could include, but not be limited to, addition of any form of temperature control system or removal of the doors/windows separating the sunroom from the host structure, the room may become non-compliant with the requirements as mandated by the Florida Buildin Code, the Florida Model Ener Code and State Statutes. OWNER i have read this complete form and underslI I am receiving a Category J—Sunroom.(I-V) printed Namc a _-._Address Signed: .�T.3M'.n� - --- Date: / licfnre me this-_- day of ��ol _in the County of D State o Flon as r al appeared h mself f and affirms all suuerncnis and declarations herein are true and accurate. .,....... KEVIN WAYNE NEWSOME Notary public at Large,Slate of_ —,county of - Personally Known❑or Produced Identification '; j•c MY COMMISSION#EE108253 u�Type – -- - --- ------ --- ---- ---------- - '., '---MIRES June 30.2015 Sunroom and Screen Enclosure Requirements Category I II III IV V Habitable Space No No No Yes Yes Foundation Walls <200plf Walls <200plf Walls <200plf can Walls <200plf Walls <200plf can can have can have have 8"Wx12"D ftg can have have 8"Wx12"D ftg 8"Wx12"D ftg or 8"Wx12"D ftg or or 3-1/2"slab if no 8"Wx12"D ftg 3-1/2" slab if no 3-1/2" slab if no concentrated load concentrated concentrated >7501b _ load >7501b load>7501b Existing exterior Relocate to Relocate to Relocate to Relocate to Relocate to GFI Breaker exterior if exterior if exterior if enclosed exterior if exterior if enclosed enclosed enclosed enclosed Exit Lighting Not Required Required— Required Required Required Interior Electric Not Required Not Required Not Required Required Required Outlets Emergency Egress from Egress and Exit Egress and Exit Egress and Egress and Exit Escape exist. structure mist meet code must meet code. Exit must meet must meet code. Openings allowed if open to code. atmosphere and has screen door leading away from residence. Misc.Window Host structure Windows must Windows may be Host structure Host structure . and Door windows/doors be removable fixed or windows& windows & doors Requirements shall not be Host structure removable. Host doors shall not may be removed. removed. windows/doors structure windows be removed. Forced entry,air shall not be and doors shall not Forced entry, leakage and water removed. be removed. air leakage penetration Forced entry, air and water requirements leakage and water penetration apply. penetration requirements requirements apply. apply. Wind Borne Not Required if Required, Required, can be unless built on host structure, Debris Opening Not Required Not Required host structure is under an if built under Protection protected existing roof existing roof Energy Sheets Not Required Not Required Not Required Required Required N �c�fY;9� •+'i,�Mq.,J'�y.'yE9t'y�/'�...;{,..;a,, .. ... is i L P YIFFANY BY THE SEA HOMEOWNERS ASSOCIATION 920 3rd STREET, SUITE B NEPTUNE BEACH, FLORIDA 32266 (904) 242-0666 July 14, 2014 VIA EMAIL: ALEXANDRA.BEIER@GMAIL.COM Shaun and Alexandra Beier 85 Nicole Lane Atlantic Beach, FL 32233 U JUL 2 9 2014 Re: Lot # 24— Screen Enclosure APPROVAL gy Dear Mr. and Mrs. Beier: This letter will serve as approval of your request for a screen enclosure per your submittal, the attached survey and drawings. It is understood that the enclosure will match the color and contour of the existing house. The homeowner -is responsible for obtaining necessary permitting and approvals Please forward a copy of the permits to this office for your file. Please note this approval is subject to all City, County, and State agency approvals, if necessary. This letter will be placed in your file for future reference. TIFFANY BY THE SEA HOMEOWNERs ASSOCIATION Attachments: As stated cc: Board of Directors a N F1 COPY AUG 11 2014 AFFIDAVIT FOR ATTACHING ANEW STRUCTURE TO AN EXISTING STRU JJVRE TO: Building Inspection Division, City of Jacksonville, 214 North Hogan Street Home Owner: —1 v IL - Name 4-1C Addrit c' )P-1- City. P-1 City. State and Zip Code Contractor: O��(� fes' X)4!2� 4" Permit Number B- - 1402 As the Contractor for the proposed new structure located at the above address, I have personally viewed with the above named home owner those portions of the existing structure on which portions of the proposed new structure are to be attached for structural support. I am confident that the drawings and details included with this permit application depict the existing conditions of the host structure,and the members of the existing structure upon which the new structure are to be attached are sound with no rot or deterioration The home owner has been advised by me that, in my best judgment based on experience and knowledge of structural adequacy,the members of the existing structure upon which the new structure are to be attached are sound with no rot or deterioration and will support all structural loads and forces imposed on them. By signing below,I hereby declare that I will hold the City of Jacksonville harmless and release it from any responsibility and liability for any adverse consequences or failures resulting from this work,and further that I will not initiate,execute or enjoin any legal action against the City of Jacksonville for such consequences or failures. A copy of this document will be recorded as an official record with the Building Inspection Division permit history so that any and all future buyers/owners of this property may be made aware of the status of "or' erformed on this structure. Sii d / Date Before me this /l day of M-01- / In the County of Duval, State of Mrida,has personally appeared do �� Iherein by himself/herself and Affirms all stat_ d declarations herein are true and accurate. No ary Public at arge, State of ,County of UY Personally Known . —or Produced Identification ID Type KEVIN WAYNE NEWSOME *_ MY COMMISSION#EE108253 EXPIRES June 30,2015 (407)398-0153 FloddallotaryService.com BUILDING PERMIT APPLICATION '�`�,�.`;cy,,.,_4Ar .asn.r+••r,v•.,.n.Ay�.'.-cJ.,...r.►'.;r'�:. CITY OF ATLANTIC BEACH „ FILE COPYAUG 082 14 a, 800 Seminole Road, Atlantic Beach, FL 32233 Office (904) 247-5826 Fax (904) 247-5845 Job Address: �� cote L t-, Permit Number: 20 7 Legal Description!._o 2 Tr-C-r(a�► 4.e G- Parcel# oor Area o q. t. � q t Valuation of Work$ Proposed Work heated/cooled non-heated/cooled A.Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s) (circle one): Commercial 49i��6 If an existing structure,is a fire sprinkler system installed? (Circle one): N/A Florida Product Approval # For multiple products use product approval form Describe in detail the type of work to be performed: >F004rS +- SCXLv_L4 " c_(psQ re SCAP_,+^ 40P Property Owner Information: Name: 1 )4 z 4A 3",_'V,_ Address: F's- p t, Czs�c LK" City �-r f3 State F Zip 2 Z 3 Phone E-Mail or Fax# (Optional) rte,ce,-3 eAc,LoS u✓e 5 7 a ulna • C-a W` Contractor Information: II rr Company Name. �ceU nc rPS �Scve e✓CQualifying Agent: �4 l�Q-t�-- Address:3500 6a&C ,W6 20� City-T State rr Zip ZZZ Office Phone "7Y Y -3 s-0 o Job Site/Contact Number i Qv 00'J Sg 1-5311 Fax# State Certification/Registration# SCG i 3l 1 S-02198 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. 1 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. months at This permit becomes null and workis� er mmenced.otI understand that sepacommenced within six rate permitsomust be secured for Electrical Work, Plums ng,Sigconstruction or work i's suspended or ns,aWellseri,P olsx �rn ces,Boilers,time Henlers, 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 BEOR ERECORDING YOUR NOTICE OF COMMEI here b certify that I 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 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 other federal,state, or local law regulating construction or the performance of construction. 7 ASignature of Owner Signature of Con S kOwM seZ�- Print Name e�'b Print Name v...................................��............................................................................. ......................................................................................................................................... Beforp me Before me 20 l this ay of 20 this y of " y ,, = �V AYN NEWSOME 'v"' KEVIN bVAYN E NEWSOME 'P Notal u -�; ;*E MY COf�RMISSION#EE1082 "- MY COMMISSION#EE108253 ised 01.26.10 EXPIRES June 30,2015 � �,,, CXPIf2ES June 30,2015 40i�e p1,3 Flor!deNotaryServlce.com (407)398-0153 F1orid3Notar Ser jce.wm TIFFANY BY THE SEA HOMEOWNERS ASSOCIATION 920 3rd STREET, SUITE B NEPTUNE BEACH, FLORIDA 32266 (904) 242-0666 July 14, 2014 VIA EMAIL: ALEXANDRA.BEIEROGMAIL.COM Shaun and Alexandra Beier 85 Nicole Lane D 011 Atlantic Beach, FL 32233 JUL 2 9 2014 Re: Lot # 24—Screen Enclosure APPROVAL gy, Dear Mr. and Mrs. Beier: This letter will serve as approval of your request for a screen enclosure per your submittal, the attached survey and drawings. It is understood that the enclosure will match the color and contour of the existing house. The homeowner,45 responsible for obtaining necessary permitting and approvals Please forward a copy of the permits to this office for your file. Please note this approval is subject to all City, County, and State agency approvals, it' necessary. This letter will be placed in your file for future reference. TIFFANY BY THE SEA HOMEOWNERS ASSOCIATION Attachments: As stated cc: Board of Directors HOMEOWNER SUNROOM ENCLOSURE AFFIDAVIT The purpose of this document is to make you aware of any limitations in the enclosure that is being permitted at your residence. The table below, Sunroom and Screen Enclosure Requirements provides a brief description of the various Sunroom category requirements. There may be restrictions on the use of your present home depending on the category Of Sunroom you are installing. The property owner is hereby notified that should they make changes to the sunroom which could include, but not be limited to, addition of any form of temperature control system or removal of the doors/windows separating the sunroom from the host structure, the room may become non-compliant with the requirements as mandated by the Florida Building Code the Florida Model Energy Code and State Statutes. — — OWNER h:nl'rr;iti(Ills crnnpletr torn,and undeZ uI II am receiving a C,ucgon'._1___Sunroom.(I-V) nicd Nanlc- - -,Q'0 -- ^ >'�:It Address i2('—__1 -- ---- — - licliac r r ibis 2 - _ da}of J /� in the County of D State o'Iloric •c al :rppcarcd �,rnd affunis all h ' nlsclfl - i, •ta enu n s.uul declarations hereinare u'uc and❑icuuu:. VIN WAYNE NEWSOME Notar•;Public at Loge,Slate e'( - __ Counly of Li "�'� C�;:;-KE- ,fI Yp ii Personally Known❑or Produced Identificutiont-13--'- •: ;': MY COMMISSION#EE108253 1 XPIRES June 30,2015 Sunroom and Screen Enclosure Requirements Category I II III IV — V Habitable Space No No No Yes Yes Foundation Walls <200pif Walls <200pif Walls <200plf can Walls <200plf Walls <200plf can can have can have have WW02"D ftg can have have 8"Wx12"D ftg 8"Wx12"D ftg or 8"Wx12"D ftg or or 3-1/2"slab if no 8"Wx12"D ftg 3-1/2" slab if no 3-1/2" slab if no concentrated load concentrated concentrated >7501b _ —load >7501b load >7501b Existing exterior Relocate to Relocate to Relocate to Relocate to Relocate to GFI Breaker exterior if exterior if exterior if enclosed exterior if exterior if enclosed enclosed_ enclosed enclosed Exit Lighting Not Required Required _ Required Required Required_ Interior Electric I Not Required Not Required Not Required I Required Required __ Outlets Emergency Egress from Egress and Exit Egress and Exit Egress and Egress and Exit Escape exist. structure must meet code must meet code. ' Exit must meet must meet code. Openings allowed if open to code. I atmosphere and has screen door leading away from residence. Misc. Window Host structure Windows must Windows may be Host structure Host structure and Door windows/doors be removable fixed or windows & windows & doors Requirements shall not be Host structure removable. Host doors shall not may be removed. removed. windows/doors structure windows be removed. Forced entry, air shall not be and doors shall not Forced entry, leakage and water removed. be removed. air leakage penetration Forced entry, air and water requirements leakage and water penetration apply. penetration requirements requirements apply. a i Wind Borne y _ J Not Required if Required, Required, can be Debris Opening unless built on host structure, Not Required Not Required host structure is under an if built under Protection protected existing roof existing roof Energy Sheets Not Required Not Required Not Required Required I Required iii�I►' •� . \��,,� • I.lb ►j�; • 'I1I�II�: c • ► � � �< .- 'rte i i • • ;l �,VA ; ♦ .. MMMMMMMMP mss " r<- City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road / q Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: Z9 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: /I/ / ���� -7) DW2ax ent review required Yes No Applicant:�/ 6 1,6a tic V Project: tiliti �L► r��i/J �� C �� Public Safety Fire Services Review fee $ Dept=Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified sry 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: XApproved. ❑Denied. (Circle one.) Comments: A n,vad �� l�•.�Crs��•�^ �/�'► l�Gv�~ Q''f J BUILDING �ru 'uA P PLANNING &ZONING rear Reviewed by: � 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 05/14/09 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 ;µ Phone(904)247-5826 • Fax(904)247-5845 Z , E-mail: building-dept@coab.us Date routed: City web-site: hftp://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: S 5 -7) F-Dpamnartment review required Yes No ng &Zoni Applicant: C 4 Tree Administrator rn���• �r�� �' lic Wor Project: /~ 1� tiiitie Public Safety Fire Servi,^9s Review fee $ Dept Signature _ Other Agency Review or Permit Required Review or Receipt Dateof 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. ❑DeniP . (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: ❑Approved as revised. ❑Dei d. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denies Comments: Reviewed by: Date: Revised 05/14/09 City of Atlantic Beach APPLICATION NUMBER Building Department i o be assigned by the Building Department.) 800 Seminole Road _ //Lo 7 Atlantic Beach, Florida 32233-5445 , ; Phone(904)247-5826 • Fax(904)24 -58dr' E-mail: building-dept@coab.us Date routed: -712. City web-site: http:/lwww.coab.us AUG 0 8 2014 G-= APPLICATION REVIi -AN&TRACKING FORM Property Address: ,1 ,L`71 D ent review required Yes No Applicant �n C ng &Zoni Tree Administrator Project: 1 �ewfiv -M!�rh C 1 W't' Public Safety Fire Services Review flee $ 6 Dept Signature Ag 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: AkDate: Il 2 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 City of Atlantic Beach APPLICATION NUMBER Building Department - -__ (To be assigned the Building Department.) �. ZD 800 Seminole Road � -���� Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)24 -5845 AUG 0 8 2014 ? Z E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.usy APPLICATION REVIEW AND TRACKING FORM Property Address: `/ (�1� � D ent review required Yes No /' Applicant:l 'n &Zoni OFireServ*ices Administrator rn � �� ��Project: t o Review or Receipt Date Other Agency Review or Permit Required 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: 41w� TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. IC WOR S Comments: IC UTILIT LIC SAFE Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. [-]Denied. Comments: Reviewed by: Date: Revised 05/14/09 PEE 1 NIIT \L`\21 1'_R .11.:01,110E OF C10NI 11.N CEM _ITT FLORIDA S 1'11x1 LI I E 713.13 S'1'A'J'E OF FLORI DA The undersigned hereby hives notice that improvement.mll be made to certain real propert),,, and in accordance. lvith Chapter 713, Florida Statutcs, the follming information is provided in the Notice of Commencclnent- J I. Description of propel i\ (:c_tl1 dCsCrlptioll (_\1 the prollcri\'. and �tlYel addrC�s Il m a11ahIC'). j Uenclal dcsu 1pU�n of impl(�\emu t. :mac r�-_t'z ti j..l-Sc r y- r ;� t1c YE Q, ~ Owner Intormali011: (( `l O v a. \lame 'an(1 addrea: c; 4lC'xe�c. � -- - ( D b. Interest m property: --f�L'�_ -� in - c. Name and address ui i' e simple. titicholdrr(il Awl- ian owner) -- - o v () a) C(�ntr ( or(\211le 1114f_ 4(1----..— a N z fir_ FL 3Z2u --- `� a.Phone. ntlmhcr: ��`ti' ' yr�Ck h F.0 nunlher. ��' cI t'SIS __._ o ° _�'C) ( `i 7 S_ f1._ o a3 0Ow ALL - IJZ�CCr)2" �. �llrcr�': a. N!smc anal ,lddres'�: h. Phone nunlhiy tax number: d. Amount of hold --__—_-- ��• 6. Lender: (\nine:uld Adi11( ; ) - ,!. Pholl I11Inllm: h. Fay number: !. PCrshns \\lthlll Ilie Slati OY' Florida h\' IIpoll \\hom lloliccs or i)lllci- docllnlellts 111m. be Ser\"Ci1 prm ldcd 111 section 1 3.1 i( 1)(a) (11:111le 911d addl-eSS) --a. Phone number: h l ax number ---- of -- - ---._ _to rvcci\e a cop\ of the Lienor's Notice a; provided in Section 713.13(1)(6). Florida Statutcs. �). Expiration dale of nolWe of C0111111encellient (1110 CNp1rmon dale 1s one ( 1 ) \'Car from ille date of I-CC.ol"CIIIIU UI]iCss:1 dll lci'i'll1 hic Is sllcclf ed) -- _ Si„ ure of 0\\ncr Print"Ile ti\\ il, to (or nflirmed) a.ld subscribed before me this day of �r �!?�. •'_, (\anle of pcic< n m11.in,�t ltcnlcnt). �/ P%.Y KEVIN 1.1VAYNE NEWSOME - ll: `1'tCr ll!1C i Skil:' C'{ I-Iorid-1 '= MY COMMISSION#EE108253 EXPIRES June 30,2015 (407)398 0153 FlorfdallotaryService.com I'cr nn Illy hno\\tl OR 111-oduccd IdollIIlc:llloll!Tvpc --