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 --