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364 6th St re-roof permit s��,��% City of Atlantic Beach APPLICATION NUMBER J�~ I'° �� Building Department (To be assigned by the Building Department.) r ` 800 Seminole Road I Q 7 J -, Atlantic Beach, Florida 32233-5445 ! 6 — \©o F - 2 ` 7 4.10 Phone(904)247-5826 • Fax(904)247-5845 x,31>r E-mail: building-dept@coab.us Date routed: 1 0 7-3 i/ � BUILDING PERMIT APPLICA'T'ION FILE COPY CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach,FL 32233 Office (904) 247-5826 Fax(904)247-5845 3--Ro©E�ZZ7 Job Address: 6 " S'7 Permit Number: Legal Description Lb EAS i 5 Foci LC) �Z7 Parcel # 1 �9 7 1 - OCCO 60 Floor Area of Sq.Ft. Sq.Ft Valuation of Work$ /6.0 Proposed Work heated/cooled (-3 O non-heated/cooled Class of Work(circle one): New Addition Alteration 4720 Move Demolition pool/spa window/door Use of existing/proposed structure(s)(circle installed? Commercial esiden If an existing structure,is a fire sprinkler s stem (Circle one): -Yes No C/A Florida Product Approval # FL- I V7 5 pa. For multiple products use product approval form Describe in detail the type of work to be performed: T E G1 R of c .501 ps LL r Z A T Roo F t N gACk O1= )+ooSE f Toce.C -4 Dcwk) —Lo D S oPE Property Owner Information: ` Lick- Name: I'PcO) R C 1- U IV's Address: 3 b(ri (or' S i f��l-ANT,C tE ACI-4 I L 3 2 233 City K.L-.lktu T 1 C 4-1 -PPC, StateELZip 32233 Phone E-Mail or Fax#(Optional) Contractor Information: Company Name: f/C'iOn"if T E I OU F/h1G //VC Qualifying Agent: D,1 114tH VP UC if l Address:3S 5 co 'Crew u-oc 1) L ti, City O e' A16 E PA2 K State J L Zip 3 2 0 73 Office Phone 104-J 7S- 7471 Job Site/Contact Number tOy-GOo-752 q Fax# /De/-?74'- 7177 State Certification/Registration# CCC-(33 ao 34 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 abandonedfor a_period of six(6)months at any time after work is commenced. I understand that separate permits must be secured for Eledricat'York,Plumbing,Signs, Wells, Pools, Furnaces,Boilers, Heaters, Tanks and Air Conditioners,eta 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 WITII YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. I hereby certify that I have read and examined thisplication and know the same to be true and correct. All provisions of laws and ordinances governing this type ofwork will he 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 Ownerq Signature of Contractor471)1/7 Print Name ,0 k) CAIv N Print Name L A V/L) Y (/4Q UG',/f Sworn to and subsc '•ed b-fore me Sworn t* and subscri'-d bef-i re this ,t I Day of �_; 20 this Day of '114,Ar_�/' I , �� '� II or,. ` THERESA M KELSEY Notary Public ""..•. THERESA M-KELSEY Notary Pu• is , sir 1=-ttotecy-PubNc'-9tete otfi°rtda-/ ,,rNY PSS•• �� %°- Notary Publk-State of Fbrld� �;My Comm.Expires Feb 11,2019 '•' M Gomm.Expires Feb 11,2019 • ;,or o sfis evi psko lr6 189750 FF 169750 ` � p Commission S Prrn-7.1 # /6-- Rea. ' ��.2 Try! NOTICE OF COMMENCEMENT' .�.AM COPY State of 'F Lco Q I.0/) Tax Folio No. County of Y U\/A L 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: 1.07 d-7 C A-S C 5 S. 005 T LOT -9 (3 L-R •7 Address of property being improved: 3(o (17.14 S I i L c N ( C B o c.1 FL 3 2 2- 33 General description of improvements: I"( & (12.O O c 322-33 Owner: RAOL e U N Yv Address: 3 4'(e (p " ST AilAI.J T I C 13C 14 L, Owner's interest in site of the improvement: 1 ml2dv e In e d‘J-_ Fee Simple Titleholder(if other than owner): SI NI PL S. Name: Contractor: AQ V AT y Y 2 o b l 11/4-)G C Address: 3 5 .COrroP >tvaOD ter ' pRe`+cs--€ .IPAQk FL 320-73 Telephone No.:Qb —a 7 t-79 7 7 Fax No: 5 A AN-E 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 1 - t_ Doc#2016228430,OR BK 17730 Page 1061, served: Name: Number Pages:1 Recorded 10/03/2016 at 11:03 AM, Address: Ronnie Fussell CLERK CIRCUIT COURT DUVAL Telephone No: Fax No: COUNTRECORDINGY $10.00 In addition to himself, owner designates the following person to receiv( 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): (e 6 THIS SPACE FOR RECORDER'S USE ONLY OWNER Sighed: Date: Y0•/4 Before me 's ,.3(7 day of S'i jtt- -2O/�0 in the County of Duval,State Of Florida,has personally appeared Notary Public at Large,Sta Florida Co .. •• s • My commission expires: -� ; 1;;9 .' Personally Known: Produced Identification: • My Som.Expires Feb 11,261< ............ Commission#FF 169750