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1921 SEMINOLE RD - SIDING .,c,. cp,k,° `s CITY OF ATLANTIC BEACH \f 800 SEMINOLE ROAD J ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 SIDING PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 16-SIDE-888 Job Type: SIDING PERMIT Description: SIDING - JAMES HARDIE LAP SIDING Estimated Value: $12,350.00 Issue Date: 4/22/2016 Expiration Date: 10/19/2016 PROPERTY ADDRESS: Address: 1921 SEMINOLE RD RE Number: 169542-0530 PROPERTY OWNER: Name: JONES. RAYMOND E Address: 1921 SEMINOLE RD GENERAL CONTRACTOR INFORMATION: Name: DUVAL CONSTRUCTION INC Address: 13221 Mendenhall PL Phone: - - PERMIT INFORMATION: FEES: PLAN CHECK FEES $55.88 BUILDING PERMIT FEE $111.75 STATE DCA SURCHARGE $2.00 STATE DBPR SURCHARGE $2.00 Total Payments: $171.63 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. �S.:L�p;.�, City of Atlantic Beach APPLICATION NUMBER J ` t? Building Department (To be assigned by the Building Department.) ii 1.:., 800 Seminole Road /- o Q Atlantic Beach, Florida 32233-5445 d �. �OC� 15—,'` '` Phone(904)247-5826 • Fax(904)247-5845 J; o' ' Email: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: i 192- S CrnIN0LC. RD Department review required Ye/-No rwilding , _ nA pP licant: -VV -(�0O� TZt0C-z"/O� unnig &Zoning Tree Administrator I Project: S L D I ,ND c Public Works Public Utilities Public Safety Fire Services Review fee $ Dept Signature Review or Receipt Other Agency Review or Permit Required 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: liKproved. ['Denied. (Circle one.) Comments: BUILDIN PLANNING &ZONING Reviewed by: Date: II I6 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 s''SJrJ�' BUILDING PERMIT APPLICATION O�( D ,., /► ‘ ITY L2FX FILE COP, 0 Seminol33: (904)247-5845 Job Address: /V/5E-HAVE a Permit Number:/6� s/ oPr Legal Description 42-1& 09.-2$2,E t 4 $DE RE# /6 2 -053 6 Valuation of Work(Replacement ost)$ f7-3. 0:Heated/Cooled SF /950 Non-Heated/Cooled 253/ I 2.--35C., • Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Doo • Use of existing/proposed structure(s) (Circle one): ommercial Residentia • If an existing structure, is a fire sprinkler system installed?(Circle one): Yes 40 N/A • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail the type of work to be performed: 51)i�6 j /�DjEL4 , _ _-I Florida Product Approval# e ,' ..._ for multiple products use product approval fonn Property Owner Information Name: lI9 P d W J 0 F-S Address: /9.2/ $z/(-'I//J04E P,) City ii1mizzl[ mn, State aZip R2223 Phone sY2=, Q E-Mail Owner or Agent (If Agent,Power of Attorney or Agency Letter Required) A///c4 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. Contractor Information: Name of Compan : L/ U5/ eli- /0) Qualifying Agent: �i,E)//0VD I'7'V? Address: /j2 / 1.7 - //,9Y City -1 pt)c State Zip ;;32 Office Phone �— 6987-..2,239 Job Site/Contact Numb 907- S6'7-2-439 State Certification/Registration# CGC /52g/So E-Mailbl,yl/ cppsrete /©kilc.C' e Ghl9/t_ con Architect Name & Phone# Engineer's Name & Phone# Worker's Compensation Fxr -e-p7- Exempt / Insurer / Lease Employees / Expiration Date 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 Tnor 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. his permit becomes null and void if work is not commenced within six(6)months, or if construction or work i. us ended or abandone,for a period of six(6)months at any time after work is commenced. 1 understand that separate permits must be secur' f Electrica Work,PI :bit:, Signs, Wells,Pools,Furnaces,Boilers,Heaters, Tanks and Conditioners,etc. 0 'K Signature of Property Owner: /4710,/v Q� Signature of Contracto . Beforp this /l ay of r� Before me this I O .y of !ill, 2-CD I ��,i I 7�-- -- -- — _4 1 6k Notary Public: i .311`,.; ,.. a 7,a 'ublico,,. t •t' ..�, •1a: EXPIR January 5,2020 ° ,v ,._ MY COMMISSION IP FF I r'.'' .r Bonded Thru*try Pubic Und.iwitto y. :, EXPIRES:October 6,2019 r I hereby cert'that I have re.-----•----------------- - ---- -- -- • kno „• e toniteTletrl�9tt0ePNd ' provisions of laws and ordinances governing this type of work will be complied with whether --•-- --- - • • $of a permit does not presume to give authority to violate or cancel the provisions of any other.federal, state, or local law regulating construction or the performance of construction. Rev.3/14/16 I P �6 S//Y ` cP NOTICE FILE COPY OF COMMENCEMENT State of �lQ0f40/9 County of Tax Folio No. To Whom It May Concern: The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of the Florida Statutes,the following information is stale4 .thiNOTICE F COMMENCEMEN . Legal Description of property being improved: Cj1 4 _ E g 4 /;• / /ate Address of property being improved: / ' / j'f��� � I . General description of improvements: I J#t) &FP A- ,t J I G i�1 X�% � � Owner: /'1� ` , � Address: ` , ,51 1QE Owner's inter site of the improvement: fib Fee Simple Titleholder(if other than owner):• Name: •Contractor: a 1/444Z- /• /0/Li//1./� • Address: • ,!J/4 PL , `,' a.- Telephone No.: 2G Fax No: Surety(if any) Address: • Amount ofBond$ Telephone No: . Fax No: Name and address of any person malting 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 maybe 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: xpiration date of Notice of Commencement(the expiration date is one(1) year from the date of recording unless a different date is )ecified): HIS SPACE FOR RECORDER'S USE ONLY OWNER F 4P,r, 9 Before this day of , ;) Date: —13 ZQ��P Doc#2016082263,OR BK 17525 Page 1 Sa, y '%`� in the County of Duval,State Number Pages:1 Of Florida,has personally appeared • Recorded 04/13/2016 at 09:37 AM, Personally Known: Ronnie Fussell CLERK CIRCUIT COURT DUVAL: Produced ldentificatio f or COUNTY Notary Public: _ j r" rims asi.m en. RECORDING$10.00 My commission expires: � ���`�' �•i• Ala i�•; EXPIRES January 5,2020 '' Nj„∎67- Bonded MN/43*y Pubic UMW,tom