371 PLAZA - DECK/ PATIO PAVERS '‘'‘-/..r./6
, sA CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
DIV - ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ALT/OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-DECK-1270
Job Type: DECK/PATIO
Description: 2 PAVER WALKWAYS IN YARD
Estimated Value: $2,000.00
Issue Date: 7/1/2015
Expiration Date: 12/28/2015
PROPERTY ADDRESS:
Address: 371 Plaza
RE Number: 170016-0000
PROPERTY OWNER:
Name: CLAYTON, THEODORE B
Address: 555 SELVA LAKES CIR
GENERAL CONTRACTOR INFORMATION:
Name: EARTH WORKS DESIGN &
Address: 11111 -70 SA SAN JOSE BLVD APT 297 11111-70 SAN
JOSE BLVD # 297
Phone: - -
PERMIT INFORMATION: PUBLIC WORKS:
Full erosion control measures must be installed and approved prior to beginning any earth
disturbing activities. Contact Public Works (247-5834) for Erosion and Sediment Control
Inspection prior to start of construction. Put silt fence fully around work area.
All silt must remain on-site during construction.
Roll off container company must be on City approved list and container cannot be placed on
City Right-of-Way. (Approved: Advanced Disposal, Realco, Republic Services, Shappel's and
Waste Pro.)
Full right-of-way restoration, including sod, is required.
FEES:
BUILDING PERMIT FEE $60.00
STATE DCA SURCHARGE $2.00
PAR c41,4q6YFFIFALY IN ACCORDANCEVRALL CI l'Y OF MIAMI(' BEACH ORDINANCES AND TIlE FLORIDA
BUILDING CODES.
CITY OF ATLANTIC BEACH
V 800 SEMINOLE ROAD
T ' s)
J ,z ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
STATE DBPR SURCHARGE $2.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE. W ITll ALL CITY OF ATLANTIC BEACH ORDINANCES AND 7'1W FLORIDA
BUILDING CODES.
CITY OF ATLANTIC BEACH
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
800 Seminole Road 904-247-5800
Si Atlantic Beach,Florida 32233-5445 Fax 904-247-5845
PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION.
Date G;
/ PERMIT# • 1
Job Address S 7/ [(O.2 a- ha ISSUED BY THE CITY
Permitee: j a-f'g C I a t6+p h Telephone# 7a 3 - [ / -3 (1 Q 8
Permittee Address: J 71 ?1a1A 2:1 A i-,•. Be_, .L , PC
Requesting Permission to Construct: C- c y c r ���K za of i �c i g?) s .�
Location: (Reference to Cross-Street)
1. Applicant declares that prior to filing this application he has ascertained the location of all existing utilities,
both aerial and underground and the accurate locations are shown on the sketches.
A Letter of Notification was mailed to the following Utilities/Municipalities:
Jacksonville Electric Authority Yes ( ) No ( ) Date:
Bell South Telephone Company Yes ( ) No ( ) Date:
Ferrell Gas Yes ( ) No ( ) Date:
Comcast
Yes ( ) No ( ) Date:
2. Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation.
alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public
Works, any or all of said poles, wires, pipes, cables or other facilities and appurtenances authorized
hereunder, shall be immediately removed from said street or easement or reset or relocated hereon as
required by the Director of Public Works, and at the expense of the Permittee unless reimbursement is
authorized.
3. All work shall meet City of Atlantic Beach or Florid Department of Transportation Standards and be
performed under the supervision of .3 Sc av FFnee (Contractor's Project
Superintendent) located at Certl. Wu rks p.5; r, d• Mw ,, e • Telephone#: 9Dy-196-0'71
4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee.
5. All city property shall be restored to its original condition as far as practical, in keeping with city specifications
and the manner satisfactory to the city.
A sketch of plans covering details of this installation, as well as, a copy of a recent survey shall be made a
part of this permit. L aliculations showing any increase in impervious area on owner's lot or in the city
Right of Way are to be included with this application.
7. This permittee shall commence actual construction in good faith with days. If the beginning date is
more than 60 days from date of permit approval, then permittee must review the permit with the Director of
Public Works to make sure no changes have occurred in the area that would affect the permitted construction.
8. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the
City's right, title and interest in the land to be entered upon and used by the holder, and the Holder will, at all
times, assume all risk of and indemnify, defend, and save harmless the City of Atlantic Beach from and
against any and all loss, damage, and cost of expenses arising in any manner of the exercise or attempted
exercises by the holder of the aforesaid rights and privileges.
9. The Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again
immediately upon completion.
OWNER /
Signed: d � Date: >1 5/27/t 5 :' �°i'.• CASSANDRA A REA '
Before me th as `/ ;ia• �,
day of I h in the County of Duval, • ►; �+ .•, MY COMMISSION#FF222947 I Of Florida,has personally appeared )•riafic C1 /Iv-'1- EXPIRES:May 10,2019
I
Notary Public at Large, State of Florida,County of Duval. 'ARE;SO BondedThuNOt�ryPubkcUndew te,
My commission expires: /0- I `j Personally Known:
Produced Identification: CGl a�wna Ct /
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
.Job Address: 3 1-7] {PJU20,. d Permit Number:
Legal Description • i ,L I Parcel#
oor rea o q. t. t
Valuation of Work$ Z1nc o Proposed Work 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 Residential
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed: � ons}�vc�i�`.� +wz5 e( t�a1�Cs q} Al 1
1. 1 ; 1 - Y" I9_8 s.�'
Property Owner Information: f
Name: Ma}iio '� key:∎ Address: '.�71 P10.z� d .
City A+la.n-4-:c 8 State f l Zip 3a.133 Phone 70 3 -q 19- 3ziOZ
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Es i44 titiorr De5;9n c} 44. ' Qualifying Agent: gO-& 1 eF
Address: lasoi Be. i. i " City 'S•eKsandii1 State Zip 3adq6
Office Phone ¶ i-TM-0711 Job Site/Contact Number 4oy-S'3$-oe7-7 Fax# fo'- 9V'6—o71 1
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 void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for aperiod of six(6)months at any time after
work is commenced. 1 understand that separate permits must be secured for Electrical Work, Plumbing,Signs, Wells, 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.
hereby certify'that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
vpe 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.
signature of Owner ek t! Signature of Contractor
/�
'rint Name Kgrif C-4-A Print Name )H '. r. '�
J k -;‘„„„\I
worn to and subscribed before me Sworn to and subscribed before me
tis 21 Day of ►'Y14.y ,20 / this ;l, Day of frijAi ,20 )C
lotary Public ; 0'''' ��'� r AREA
r MY COMMISSIONIFF22294 =ry Public
EXPIRES:May 10,2019 .
t8;,,1,: Bonded mN Notary Pubic Underwriters Revised 01.26.10
R.O.W. Permit Attachment of for
R.O.W. Permit# issued , 200_ Atlantic Beach, FL 32233
Owner's Name: ,�,� C�aJ 4.6 N
Property Address: 371 l/a.z Rcf
Subdivision:
Lot#/ Block #: CO 3 y /8tock if
R.E. #:
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of
, 200, by Atlantic Beach, Florida, a municipal corporation organized and existing
under the laws of the State of Florida, hereinafter referred to as "CITY" and
of Atlantic Beach, Florida, hereinafter referred to as "USER".
WITNESSETH:
That the CITY does hereby grant the USER permission on a revocable basis as described herein the
right to enter upon the property of the City of Atlantic Beach for the purpose as described in the City of
Atlantic Beach Right-of-Way/Easement permit numbers noted above (copies attached).
This work is generally described as: . , Sky ; + d Ver ,
S.P. •
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted
remains subject to relocation or removal on thirty (30) days notice by CITY to the USER, said notice to
USER shall be given by certified mail, return receipt requested, to the following address:
37 / Plaa.
z 441 'u � U���°h ,F'c. 5.1x33
The depositing of said notice of cancellation in the United States mail shall constitute the notice of
cancellation and the burden is upon USER to keep the CITY informed of USER's proper address.
The USER shall promptly make any and all necessary repairs to any facility erected or maintained in
the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe
condition.
In the event it is necessary for the CITY or the City's approved representative or other franchised
utility to enter upon the above-described property of the CITY, the USER shall replace at the USER's
sole expense, any and all material necessarily displaced during the action of maintaining, repairing,
operating, replacing, or adding to of the utilities and facilities of the CITY or franchise utility provider.
The facilities allowed by the permit shall meet the current requirements of the City Code, Building
Codes, Land Development Code, and all other land use and code requirements of the CITY, including
City Code Section 19-7 (h) which states "Driveways that cross sidewalks: City sidewalks may not be
replaced with other materials, but must be replaced with smooth concrete left natural in color so that it
matches the existing and adjoining sidewalks."
Page 1 of 2
The USER, prior to making any changes from the approved plans and/or method, must obtain
written approval from the City of Atlantic Beach, Public Works Department, for said change. The
USER shall, at the discretion of the CITY, be requested to submit as-built drawings showing the change
within thirty(30)days after the day of completion.
This permit shall inure to the benefit of and be binding upon, the USER and their respective
successors and assigns.
USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY
laws and/or specifications, to include utilities locate requirements and use limitations/requirements of
public rights-of-way and other public land. USER further agrees that the CITY and its officers and
employees shall be saved harmless by the USER from any of the work herein under the terms of this
permit and that all of said liabilities are hereby assumed by the USER.
DATED and SIGNED this day of
y , 200 .
By:
(./(4
Property Owner
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this 9.1 day of yh or.-, , 20Q,'personally appeared before me, a Notary
Public in and for said County and State, � ,� /ate the property owner of
3 ?/ Rea,.. Qd , Atlantic Beach, Florida, known to me to be the person(s)
described in and who executed the foregoing instrument; who acknowledged to me that he or she
executed the same freely and voluntarily and •__ --_._ .
' ' •• -.n mentioned.
' f n' CASSANDRA AREA
?*. *` MY COMMISSION#FF 222
947
Caov 4'nv� . J Q _/ EXPIRES:May 10,2019
Notary Public in for said County and State eoaearnN�o�a,yP°b"`"", ,
CITY OF ATLANTIC BEACH, FLORIDA, a
municipal corporation:
A
Dou1s yton, Publi7Mork/i irector
For Permits where city sidewalk is impacted,
City Manager approval required:
Nelson Van Liere, City Manager
Page 2 of 2
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CITY OF ATLANTIC BEACH
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
U
800 Seminole Road l 904-247-5800
9r: Atlantic Beach,Florida 32233-5445 h., Fax 904=24415845
PLEASE SUBMIT(3) COMPLETE SETS OF PLANS WITH APPLICATION. lI MAY 9
Date
PERMIT#
`` ISSUED BY—T.-Fit-CITY- ---
Job Address I (aZo- �,d
Permitee: C I a t!\+O h Telephone# 703 -47/7 Y./ 08
Permittee Address: 7/ Pia 32,)33
Requesting Permission to Construct: 2- avcr LA.) wail �.� c, *c, c \ a 19$ s .--(
Location: (Reference to Cross-Street)
1. Applicant declares that prior to filing this application he has ascertained the location of all existing utilities,
both aerial and underground and the accurate locations are shown on the sketches.
A Letter of Notification was mailed to the following Utilities/Municipalities:
Jacksonville Electric Authority Yes ( ) No ( ) Date:
Bell South Telephone Company Yes ( ) No ( ) Date:
Ferrell Gas Yes ( ) No ( ) Date:
Comcast Yes ( ) No ( ) Date:
2. Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation,
alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public
Works, any or all of said poles, wires, pipes, cables or other facilities and appurtenances authorized
hereunder, shall be immediately removed from said street or easement or reset or relocated hereon as
required by the Director of Public Works, and at the expense of the Permittee unless reimbursement is
authorized.
3. All work shall meet City of Atlantic Beach or Florid Department of Transportation Standards and be
performed under the supervision of -3 85,0v, FFn.e (Contractor's Project
Superintendent) located at Eaci-k Wor -
ks QS:o�t� - I"�'b�%n>J ;,,Z • Telephone#: QDV-q'96-o'71a
4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee.
5. All city property shall be restored to its original condition as far as practical, in keeping with city specifications
and the manner satisfactory to the city.
6. A sketch of plans covering details of this installation, as well as, a copy of a recent survey shall be made a
part of this permit. Calculations showing any increase in impervious area on owner's lot or in the city
Right of Way are to be included with this application.
7. This permittee shall commence actual construction in good faith with days. If the beginning date is
more than 60 days from date of permit approval, then permittee must review the permit with the Director of
Public Works to make sure no changes have occurred in the area that would affect the permitted construction.
8. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the
City's right, title and interest in the land to be entered upon and used by the holder, and the Holder will, at all
times, assume all risk of and indemnify, defend, and save harmless the City of Atlantic Beach from and
against any and all loss, damage, and cost of expenses arising in any manner of the exercise or attempted
exercises by the holder of the aforesaid rights and privileges.
9. The Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again
immediately upon completion.
OWNER
Signed: Q ,� e6--• Date: 1�Ir
s/Z7I1S :: 'r`•.^-V CASSANDRA AREA
Before me th at'7 day of /11.1 in the County of Duval, MY COMMISSION M FF 222947
State Of Florida, has personally appeared I'< . C) hrvi- -i-o EXPIRES:May 10,2019
Notary Public at Large,State of Florida,County of Duval. q(;tt 8ondedThuNOtYyPuDwcUndewriters
My commission expires: s/v- ! `3 Personally Known: n /
&L. //
Produced Identification: C� �A�r�aw
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 3 71 Pkkczc,. Rd Permit Number:
Legal Description Col 3q 6k(< L Parcel#
ao F oor Area of Sq.Ft. Sq.r't
Valuation of Work$ Z/6() 5, Proposed Work 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 Residential
If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed: �'ons vc.-k\r +wa - aycr wAk\Cs qk- al l
c 4 118 s.-1'
Property Owner Information:
Name: Katie n Address: '�7( P10.Zc.. d .
City R}lw.h-4-4c State f t Zip 3 aa33 Phone 70 3 -q l Q og
E-Mail or Fax#(Optional) ��
Contractor Information: T
Company Name: EOM% Woc'KS Je5;,j a /11/..:44. • Qualifying Agent: .asoon F'F
Address: 1a5°, $e,.ek F3/✓a City '.�eKson Ili/le_ State Zip 3a1'I
Office Phone `jb i-9y6-07/. Job Site/Contact Number goy-615-Pee7 y Fax# goti- n6-071/
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 void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six 6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing,Signs, Wells, 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 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.
Signature of Owner g /,4;../ Signature of Contractor
Print Name ....kivral y Print Name )1' r` � 1,
°si
Sworn to and subscribed before me Sworn to and subscribed before me
this a Day of /Vial , 20 1s- this a-1 Day of t)1.-. ,20 Is
Caa44.r, a. C".a4.4617lAL1.A.,
Notary Public Public cnssNCIFIaA'REA ry Public
.: •, ,.__ MY COMMISSION w FF 22294T
EXPIRES:May 10,2019
,o ,tg Bonded Thin Notary Pubic Undenentea Revised 01.26.10
..vi_w ..�
R.O.W. Permit Attachment of for
R.O.W. Permit# issued , 200_ Atlantic Beach, FL 32233
Owner's Name: ,41e, C(a f s
Property Address: 371
, cc 34.33
Subdivision:
Lot #/Block#: CO 311 I Bled i f
R.E. #:
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of
, 200_, by Atlantic Beach, Florida, a municipal corporation organized and existing
under the laws of the State of Florida, hereinafter referred to as "CITY" and
of Atlantic Beach, Florida, hereinafter referred to as "USER".
WITNESSETH:
That the CITY does hereby grant the USER permission on a revocable basis as described herein the
right to enter upon the property of the City of Atlantic Beach for the purpose as described in the City of
Atlantic Beach Right-of-Way/Easement permit numbers noted above(copies attached).
This work is generally described as: Om
Sf vt;A*6 �-Wd pa.Ver ( (ks & &II
}-n+( 61) Bit S.P.
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted
remains subject to relocation or removal on thirty (30) days notice by CITY to the USER, said notice to
USER shall be given by certified mail, return receipt requested, to the following address:
The depositing of said notice of cancellation in the United States mail shall constitute the notice of
cancellation and the burden is upon USER to keep the CITY informed of USER's proper address.
The USER shall promptly make any and all necessary repairs to any facility erected or maintained in
the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe
condition.
In the event it is necessary for the CITY or the City's approved representative or other franchised
utility to enter upon the above-described property of the CITY, the USER shall replace at the USER's
sole expense, any and all material necessarily displaced during the action of maintaining, repairing,
operating, replacing, or adding to of the utilities and facilities of the CITY or franchise utility provider.
The facilities allowed by the permit shall meet the current requirements of the City Code, Building
Codes, Land Development Code, and all other land use and code requirements of the CITY, including
City Code Section 19-7 (h) which states "Driveways that cross sidewalks: City sidewalks may not be
replaced with other materials, but must be replaced with smooth concrete left natural in color so that it
matches the existing and adjoining sidewalks."
Page 1 of 2
The USER, prior to making any changes from the approved plans and/or method, must obtain
written approval from the City of Atlantic Beach, Public Works Department, for said change. The
USER shall, at the discretion of the CITY, be requested to submit as-built drawings showing the change
within thirty(30) days after the day of completion.
This permit shall inure to the benefit of, and be binding upon, the USER and their respective
successors and assigns.
USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY
laws and/or specifications, to include utilities locate requirements and use limitations/requirements of
public rights-of-way and other public land. USER further agrees that the CITY and its officers and
employees shall be saved harmless by the USER from any of the work herein under the terms of this
permit and that all of said liabilities are hereby assumed by the USER.
DATED and SIGNED this day of , 200_.
By:
Property Owner
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this 9.1 day of n'1o�- , 20p rpersonally appeared before me, a Notary
Public in and for said County and State, kq fie, C/ct./-)ur) , the property owner of
3 71 Ploy,t... Qd , Atlantic Beach, Florida, known to me to be the person(s)
described in and who executed the foregoing instrument; who acknowledged to me that he or she
executed the same freely and voluntarily and *''- ^ra r,.,I,,,^P^ +"r''. mentioned.
"''• CASSANDRA a REA
(+ MY COMMISSION t FF 222947
Caao EXPIRES.May 10,2019
'/,41;1.: Bonded Thru Notary. pubic Undenvnters
Notary Public in for said County and State •
CITY OF ATLANTIC BEACH, FLORIDA, a
municipal corporation:
Approved:
Doug Layton, Public Works Director
For Permits where city sidewalk is impacted,
City Manager approval required:
Nelson Van Liere, City Manager
Page 2 of 2
NOTICE OF COMMENCEMENT
State of r G0(`1 Tax Folio No.
County of VP...
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:
Address of property being improved: 371 zc,. J L
General description of improvements: Cototrcle jt..4-ruts), .KNO [ .de c to IBS &F -(l ' o4.'( o '
9 e s.c'. /1 U r�
Owner: X�..4e l_ic t i-or Address: 37 I PO. CA- +lr.a ��1,��G Be,N1j,PL
U 3aa33
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: eec}h lOv(d3 DO. h &
Address: 126 of P ci..d €jl Vd -3-041 n Ole , FL 3Z2.f 6
Telephone No.: giO 'j-If‘‘ - O7/. Fax No:
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 OWNER
Signed: t((/ Date: ty 2 7/15
Before me this I day of PI . in the Cou of Duval,State
Of Florida.has personally appeared'e C/ay ton
Notary Public at Large,State of Florida,County of Duval.
My commission expires: S-/0- 9
Personally Known: -�
Produced Identification: ; CASSANDRA A.REA
, - MY COMMISSION tFF222
947
t o4 J --it EXPIRES:
May 10,2019
*,Rugs,' Bonded Thru Notary Pubis Underwriters
.
MAP SHOWI,JG BOUNDARY SURVEY OF
LOT 34. BLOCK 11. PLAT NC :, S i'Cv;SOON "A", ATLANT,C. BEACH, AS RECORDED IN PLAT BOOK =.
PACE 69. OF THE CLKRENr PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO
JULIE ANN TYSON
P.F.C. LOANS, !N.C. ITS SUCCESSORS AND/OR ASSIGNS AS THEIR INTEREST MAY APPEAR
PONTE VEDRA TITLE. LLC
COMMONWEALTH LAND TITLE INSURANCE COMPANY
LOT 35 I LOT 33 I LOT 31
BLOCK 11 1 BLOCK 11 I BLOCK 11
50.00' (PLAT)
N 83'59'05' E
50.09' (MEASURED)
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•, -HIM Ray Thompson
• mil. SURVEYING, inc. oATT.
1r a RIME !Going the DISTANCE for You!
I 111101•U 4613 Philips Highway.Suite 210 PONTE VEDR TITLE, L.L.C.
Iv : .I IUD• Jacksonville.Fiona 32207
1 I II IMAM (Phone)904448-5125
(Fax) 904-4484178 _
JOB # 543F. I DATE „ i;Ei. SURVEY: 10-20-2008 I
CC�� CERTIF'CA'r ,
.BEACMOS ARE EASED ON THE ASSUkak REARING OF--Sf_CKCQQQQ_Y''___ •
AND tin. R" - - ' ,/D,FIG re. v.'�.,y'}- '�?:0,E
ALONG 7NE RES1ERty aGtIDARP UNE Or WRAC'PARCEL BOARD C P -T.,9 I_..F.:A
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DATED: APlOL 77.79e9.COWUNTY PANEL No► : 72007$ _QQW_D ,
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.Si,a t,.11 City of Atlantic Beach APPLICATION NUMBER
Jt r \ Building Department (To be assigned by t e Building Department.)
f;`•,- "j 800 Seminole Road # c w /2-7d
�., -, Atlantic Beach, Florida 32233-5445
Phone(904) 247-5826 • Fax(904) 247-5845 �rA —
%`',�;t 91- E-mail: building-dept @coab.us Date routed:
City web-site: http:l/www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 37[ /LA 2 Department review required Yes No
Applicant: LY4/1 Q r PI nni g &Zoning
Tree Adminis ra or
Project: .11 _ . H
ublic Works
Public ttilities
Public Safety
Fire Services
Review fee $ Dept Signature
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. I ]Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: �� v/ Date: (//.�/IS
TREE ADMIN. Second Review:
❑Approved as revised. [ Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: I 'Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
t..u.r 1. City of Atlantic Beach RECI I
s'' �" APPLICATION NUMBER
a� ,:1 Building Department
� j (To be assigned by a Building Department.
j - �,:���� 800 Seminole Road J UP Q 1.1�15 Department.)
�7 Atlantic Beach, Florida 32233-5445 /5
Phone(904) 247-5826 - Fax(904 5845 1 J ' C/
w /27d
.'„ri;3 Dr E-mail: building-dept @coab.us
Date routed: cc Z 7//.5.-City web-site: http://www.coab.us ///
APPLICATION REVIEW AND TRACKING FORM
Property Address: 37i Ai 2 ,t... Department review required Yes No
B .
Applicant: iliatig>ta , d _ .. Planning &Zoning
Tree Administrator
Project: —e11/£� �',t,��+�� w 7.5 �ublic Work ub1ic Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified By Date
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: L pproved. ['Denied.
(Circle one.) Comments:
BUILDING $ft �,7c,(.r1 0
PLANNING&ZONING ,, � /Reviewed by: /=_
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