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1889 ATLANTIC BEACH DR - PERMIT S rVI f, ;I:: � �s f CITY OF ATLANTIC BEACH - _r �� 800 SEMINOLE ROAD J ` ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 SINGLE FAMILY DWELLING NEW MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 16-SFR-1380 Job Type: SINGLE FAMILY RESIDENCE Description: NEW SINGLE FAMILY -- Estimated Value: $373,290.00 Issue Date: 7/7/2016 Expiration Date: 1/3/2017 PROPERTY ADDRESS: Address: 1889 ATLANTIC BEACH DR RE Number: None GENERAL CONTRACTOR INFORMATION: Name: TOLL BROS..INC Address: 250 GIBRALTAR RD STEVEN R MERTEN Phone: - - PERMIT INFORMATION: FEES: ENG REV RESIDENTIAL BLD $100.00 PLAN CHECK FEES $649.94 UTIL REV RESIDENTIAL BLDG $50.00 BUILDING PERMIT FEE $1,299.87 STATE DCA SURCHARGE $19.50 STATE DBPR SURCHARGE $19.50 SEWER SDC-SYSTEM DEV CHG $4,050.00 ! YEI Cti(Sil kNECTOiAR•844./I W tR\( I:$070.QQL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA RI II DING CODES. \\N____ e S f CITY OF ATLANTIC BEACH 4 s) 800 SEMINOLE ROAD ^ 014'•14-- in; : ATLANTIC BEACH, FL 32233 _ INSPECTION PHONE LINE 247-5814 WATER CROSS CONNECTION $50.00 WATER SDC-SYSTEM DEV CHG $1,140.00 Total Payments: $7,748.81 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. ,-0-wrn City of Atlantic Beach APPLICATION NUMBER ••.*' ,a - Building Department • - (To be assigned by the Building Department.) • 800 Seminole Road 3' '•,• Atlantic Beach, Florida 32233-5445 f G S ER.' 13 g 0 + • Phone(904)247-5826 • Fax(904)247-5845 / Lr- E-mail: building-dept@coab.us Date routed: 6/ s /1 (.47 City web-site: http://www.coab.us 111 APPLICATION REVIEW AND TRACKING FORM L7f� Property Address: 184.4" t4 Department review required Yes No ,(Kuilding.) Applicant: ( C7 LC l i l ts(�1�S i anning &Zonin Tree Adminis rator Project: IVj�1,0 I N.D CLF kALL/ u lic Works �,�U M� I ublic Utilities�j 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. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING y �' ��/ ` v Reviewed b TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ElApproved as revised. ❑Denied. Comments: Reviewed by: Date: 2evised 05/14/09 sy�I;�N City of Atlantic Beach reEiVre APPLICATION NUMBER Building Dtment� epar - (To be assigned by the Building bepartment.) 800 Seminole Road UN. 'v c �OT15`` r� Atlantic Beach, Florida 32233-5445 i s1 �. ' jVPhone(904)247-5826 • Fax(904)24 `�o�;ijJr E-mail: building-dept@coab.us Date routed: (p City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: I ff ��(C.1101-1 e 6-An Department review required Yes No uildin. Applicant: I C7 Lc,,_. N I S ,ening &Zonin•, Tree Adminis rator Project: 1� ,0 I ublic k Utilities -C ME- Public Safety Fire Services Review fee $ Yo 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. DDenied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by:_ " ' Date: b7//‘ TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑Denied. IC WO <S Comments: PUBLIC UTILITIES 4-I6 -(4p PUBLIC SATY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: tevised 05/14/09 r \ City of Atlantic Beach eCep.��►--w APPLICATION NUMBER --— Building Department . - - • (To be assigned by the Building Department.) ` 800 Seminole Road JUN 1 6 Zino , ii35 -e Atlantic Beach, Florida 32233-5445 Gj S ER. 0 • Phone(904)247-5826 • Fax(904)247- 5 \onio- E-mail: building-dept@coab.us Date routed: 6/ (S /1 City web-site: http://www.coab.us ttt APPLICATION REVIEW AND TRACKING FORM Tht- Property Address: 18 ' ( 't UPtio'ra e ��q� Department review required Yes No (uildinq) Applicant: ( C7 L( . Cy C jZ S Panning &Zonin Tree Administrator Project: k_) j /06, N--C)M& t �blic Utilities� 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: APPLI ATION STATUS Reviewing Department First Review: RApproved. ['Denied. (Circle one.) Comments: fie 116Jt d 4gew BUILDING •7 Tj`' '� PLANNING &ZONING AA.511,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: QApproved as revised. ❑Denied. Comments: Reviewed by: Date: levised 05/14/09 Id'! ? *I/ c Jte4 /14q ___14;$ /OM( k• lli,A37 #0,4e .t,r7,3 ,c 197 - 32,z Tr.3�_Y- r 9. F k 2, 7 � � 3• gt wr >l• � xb 70 CQd4/4 /v 4 / 9: 7 X /y- ? 9p ..72/E,4444/44 42 ,71 kriklAto2 t, 6 .-/6 .-4 R.O.W.Permit Attachment of for R.O.W.Permit# issued ,2016 Atlantic Beach,FL 32233 Owner's Name: Toll FL VI,LP Property Address: 1889 Atlantic Beach Drive Atlantic Beach,FL 32233 Subdivision: Atlantic Beach Country Club Lot#/Block#: 56 RE.#: 169505-1575 REVOCABLE ENCROACHMENT PERMIT THIS REVOCABLE ENCROACHMENT PERMIT,issued on this day of ,20 ,by Atlantic Beach,Florida,a municipal corporation organized and existing under the Iaws of the State of Florida,hereinafter referred to as"CITY"and Toll FL VI,LP 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: Pavers in the Right of Way for the driveway. 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: 160 Cape May Ave.Ponte Vedra,FL 32081. 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 SIG .i i 's /0 day of ,2016. By: A#� Steve ert Ora FL VI,LP. (to ,- signed in presence of the Notary) STATE OF FLORIDA COUNTY OF DUVAL On this la day of June 2016,personally appeared before me,a Notary Public in and for said County and State, St.Johns,Florida ,the property owner of 1889 Atlantic Beach Drive,Atlantic Beach, Florida, known to me to be the person(s) described in and who executed the foregoing instrument• o acknowledged to me that he or she executed the same freely and voluntarily and for the uses an• purp.ses therein mentioned. 1 -------------- =41'." ;•• MELISSA LIEBERMAN Notary 'i'. in for said County and State _` c MY COMMISSIONFF055605 C7::7,4... .,� CITY c ANTIC BEACH,FLORIDA,a .'rE o, .0-o1:4;) EXPIRES September 18,2017 municip. corporation: (407)398.0153 FloridallotaryService.com Approved: q / ••.• : public ofrks Director For Permits where city sidewalk is impacted, City Manager approval required: Nelson Van Liere,City Manager Page 2 of 2 I MAP SHOWING PLOT PLAN OF LOT 56 AS SHOWN ON MAP OF ATLANTIC BEACH COUNTRY CLUB UNIT 2 AS RECORDED IN PLAT BOOK 67 PAGES 132-137 OF THE CURRENT PUBLIC RECORDS OF DWAL COUNTY, FLA. CERTIFIED TO: TOLL BROTHERS LAND DEVELOPMENT ://7/ 1j CURVE DATA C2 OQ ' S59'37'08"E • CH = 128.18' il ' R =g170.00' A 131.43' p .044'17'48' ```�� 00610,.0 C co&SF 0 I 37.4' meq, 1 SOT \\ l� ZJ3 (!'gcgHlJ G \\ �S h n N I \\ OS/1� JI cQ 3� `•q4 aq�D• :;` \ • dI °�\v._� ��oRcy� A;j \ ., ii i "\'''' , , Z I yOO RFSSrOMSFO �tti // , F R °c� / 1 e2 , o F I w �vNeF °� �` oa�4S qSl &_ 4k�.,0 ��� 1 •A:4-.ep••o0 gSi4.. •/6 //f Y:'ce,, '. (.2"9 I� I (17 sp // po',4aoo9-° L1 N30'24'17"E • 12'„ , 4' b 13.09' 1 • • pb h p?�o ��• �y0 WOO'JEW ,'• opsAx �eR a / N EQUIPMENT ,/ Q`EASEMENT �� t X, % �Py / a4 h • or i. ';' � a ' N / c.,0 • • .CYC :,ya '4w Qaci . 2R,ao 4'`;l:i:::P \ k_Ar''.0,z. O _ __ .--_12,-- ENOTES OIREC1rnN OF FLOW AtrsCITY OF ATLANTIC BEACH PUBLIC UTILITIES fic 1200 Sandpiper Lane ATLANTIC BEACH,FL 32233 "1:401119 (904)270-2535 or(904)247-5874 NEW WATER/SEWER TAP REQUEST Date: &-/6, —/& Project Address: 88 9 , � D� No. of Units: Commercial Residential ✓ Multi-Family New Water Tap(s)& MeteMeter Sizes '� r(s) ( ) 3/c New Irrigation Meter ' Upgrade Existing Meter from to (size) New Reclaim Water Meter /Size 11 New Connection to City Sewer Name: Applicant Address: City: State: Zip Phone Number: Cell Number: Email Address Fax: Signature: (Applicant) CITY STAFF USE ONLY Application# /(d - sFre.-/3 8 ) Water System Development Charge $ / /i_ 10_ O Sewer System Development Charge $ ,O ,LCX) 00 Water Meter Only $ /8S 00 '7310 Reclaim Meter Only $ /6 00 / Water Meter Tap $ (notes) Sewer Tap $ Cross Connection $ LS-0. Other $ TOTAL $S to/0. CX) APPROVED: Kavle Moore, PE (Deputy PW Director or A-Vilized Signature) ALL TAP REQUEST MUST BE APPROVED BY UTLITIES DEPARTMENT BEFORE FEES CAN BE ASSESSED l 1 rfEJ " , City of Atlantic Beach APPLICATION NUMBER 4' JBuilding Department (To be assigned by the Building Department.) ' }` 800 Seminole Road 1 SFR - 135 135 0 �� Atlantic Beach, Florida 32233-5445 lJ Phone(904)247-5826 • Fax(904)247-5845 �o;;,,';- E-mail: building-dept@coab.us Date routed: D t s /I Co City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 18Bc1 `t t /0-11 0 I�Q0k0t4 Department review required Yes o uildin Applicant: Winning &Zonin f� Tree Administrator I Project: �v G� i ISG c� AY1/1, t u lic Works] L�-( blic Utilitie� M& 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: pproved. ❑Denied. (Circle one.) Comments: BUILDING' PLANNING &ZONING Reviewed by: /721 Date: 6 '0416 TREE ADMIN. Second Review: Approved as revised. ❑De i d. 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 BUILDING PERMIT APPLICATION OFFICE COPY CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach,FL 32233 Office(904)247-5826 Fax(904)247-5845 �+ Job Address: 1889 Atlantic Beach Drive:Atlantic Beach.FL 32233 Permit Number: /6— 5`FR—/380 Legal Description Lot 56 Atlantic Beach Country Club Unit 2 67-132-08-2S-29E.259 Parcel Floor Area of Sqq.Ft Sq.Ft Valuation of Work S 373,290 Proposed Work heated/cooled 3,242 non-heated/cooled 930 Class of Work(circle one): 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 spnnkler system installed?(Circle one): /A Florida Product Approval#See attached �_ For multiple products use product approval form Describe in detail the type of work to be performed:New Residential Construction Property Owner Information: Name:TOLL FL VI LIMITED PARTNERSHIP Address: 160 Cape May Avenue City Ponte Vedra State FL Zip 32081 Phone 904 217-0739 E-Mail or Fax#(Optional)arogers@tollbrothers.com Contractor Information: CONTRACTOR EMAIL ADDRESS: aroeersatollbrothers.com Company Name:Toll Bros.,Inc.Qualifying Agent:Steven R.Merten Address: 160 Cape May Avenue City Ponte Vedra State FL Zip 32081 Office Phone 904 217-0739 Job Site/Contact Number 904 386-6472 Fax# State Certification/Registration#CGC 1510225 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 cern),that no work or installation has commenced prior to the issuance of a permit and that at/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 ifconstruction or work is suspended or abandoned for a period of six(6)months at anytime 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,de 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 cert that I have read and examined this application and brow the same to be true and correct. All provisionsof 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. A' Signature of Owner /�� Signature of Contractor Print Name Steven • erten•s vi 'on Sr.Vice President Print Name Steven R. erten Before me Before me this• !: of June 2016 this 9 Da . June .2016 A No. ' b'c Notary Pub. Revised 01.26.10 / ''°\ MELISSA LIEBERMAN MY COMMISSION#FF055605 ;:••pYP�..,. sQr .po o. °�'. MELISSA LIEBERMAN .,,. OFre. EXPIRES September 18.2017 `r, ,A o,, FtoridallotaryService.com �r MY COMMISSION#FF055605 (407)398-0153 'o v,--eoP.' EXPIRES September 18,2017 (407)398-0153 FloridnNotaryService.com Ad03 331110 DO NOT WRITE BELOW- OFFICE USE ONLY AMP Applicable Codes: 2010 FLORIDA BUILDING CODE Review Result (circle one): Approved Disapproved Approved w/ Conditions Review Initials/Date: /� 6 . 7216 OFFICE COPY Development Size Habitable Space 301'I S Non-Habitable ? go S' / Impervious area Miscellaneous Information Occupancy Group ;i2- Type of Construction V ( Number of Stories ?% Zoning District i i3 Le- Max. Occupancy Load Fire. Sprinklers Required Flood Zone X Conditions/Comments: OFFICE COPY R.O.W.Permit Attachment of for R.O.W.Permit# issued ,2016 Atlantic Beach,FL 32233 Owner's Name: Toll FL VI,LP Property Address: 1889 Atlantic Beach Drive Atlantic Beach,FL 32233 Subdivision: Atlantic Beach Country Club Lot#/Block#: 56 R.E.#: 169505-1575 REVOCABLE ENCROACHMENT PERMIT THIS REVOCABLE ENCROACHMENT PERMIT,issued on this day of ,20 ,by Atlantic Beach,Florida,a municipal corporation organized and existing under the laws of the State of Florida,hereinafter referred to as"CITY"and Toll FL VI,LP 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: Pavers in the Right of Way for the driveway. 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: 160 Cape May Ave.Ponte Vedra,FL 32081. 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 0 The USER, prior to making any changes from the approved plans and/or method, must obtain 11 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 n within thirty(30)days after the day of completion. rn This permit shall inure to the benefit of, and be binding upon, the USER and their respective successors and assigns. n USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY 0 laws and/or specifications, to include utilities locate requirements and use limitations/requirements of 014. 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 SIGN 0 + 's /0 day of ,2016. By: .di Steve ert moll FL VI,LP. (to ,- signed in presence of the Notary) STATE OF FLORIDA COUNTY OF DUVAL On this ea day of June ,2016,personally appeared before me,a Notary Public in and for said County and State, St.Johns,Florida ,the property owner of 1889 Atlantic Beach Drive,Atlantic Beach, Florida, known to me to be the person(s) described in and who executed the foregoing instrument. •o acknowledged to me that he or she executed the same freely and voluntarily and for the uses an, purp•ses therein mentioned. ;It.47.9,-,',..,..1MELISSALIEBERPJIANNotary r4: in for said County and State u MY cLoin SSION#EFF055605 --9 ` �>p;_ EXPIRES September 18,2017 CITY I ANTIC BEACH,FLORIDA,a :'F o.F,�•. municip• corporation: (407)398-0153 floridallotaryService.com Approved: Doug Layton,Public Works Director 11 For Permits where city sidewalk is impacted, City Manager approval required: Nelson Van Liere,City Manager Page 2 of 2 • OFFICE COPY NOTICE OF COMMENCEMENT State of:_FLORIDA • Tax Folio No. 169505-1575 County of: DUVAL 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: Lot 56 Atlantic Beach Country Club Unit 2,67-132 08-2S-29E.259 Address of property being improved: 1889 ATLANTIC BEACH DRIVE,ATLANTIC BEACH,FL 32233 General description of improvements: NEW HOME CONSTRUCTION Owner:TOLL FL VI LIMITED PARTNERSHIP Address: 250 GIBRALTAR RD. HORSHAM,PA 19044 Owner's interest in site of the improvement: FEE SIMPLE . Fee Simple Titleholder(if other than owner): Name: Contractor: TOLL BROS.,INC. r-4)0/6.Address: 160 CAPE MAY AVE. PONTE VEDRA,FL 32081 Telephone No: 904-217-3852 Fax No: 904-460-2683 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: STEVE MERTEN Address: 160 CAPE MAY AVE.PONTE VEDRA,FL 32081 Telephone No: 904-217-3852 Fax No: 904-460-2683 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: 11 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): 06/30/17 THIS SPACE FOR RECORDER'S USE ONLY OWNER / Signed: Date: Before me Q' ID clay of i(,(np , in the Countyof Duval,State Doc#2016132034,OR BK 17593 Page 2061, )f Florida, as personally appeared S-{ ' ��r-}E'i(1 Number Pages:1 notary Public at Large,Stao I tori a,County of Duval. Recorded 06/10/2016 at 01:45 PM, 44y commission expires:/ /1017 Ronnie Fussell CLERK CIRCUIT COURT DUVAL ersonatly Known: V or COUNTY roduccd Idcntitic,tion• RECORDING$10.00 :':P" "."e~ MLIEBM MY COMMISSION ELISSA *{FF05SER (iAN05 v',:\<-OeS EXPIRES September 18.2017 • (407)398.0153 FloridallolaryService.com '""' V CO ---1 O\ Cn w tJ -- CO ON V, .P w IJ O O� • a Ch o• a s CT o °— C7 w va5 . 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