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1360 Ocean Blvd fence permit City of Atlantic Beach APPLICATION NUMBER Building Department Cro be assigned by the Building Department.) 800 Seminole Road o Atlantic Beach,Florida 32233-5445 Phone(9154)247-5826 - Fax(904)247-5845 E-mail: building-dept@mab.us Date routed: Cityweb-site: hftp:/Mnvw.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: (Xo Ixtail ��Jd D ant review re uired No Applicant: Elanning &Zon@g TirgeAdMinistrator Project: � Lpku'Lp- a bfi,UtffifieR) —rublic—Safety Fire Services Other Agency Review or Permit Required Review or Race pt Date of Permit Verified By Florida Dept.ofinvironmental Protection -Florida Dept.of Transportation St.Johns River Water Management District pwny corps of Engineers Division of Hotels and Restaurants Division of Al be= Other: APPLICATION STATUS Reviewing Department First Review: MApproved. []Denied. (Circle one.) Comments: PLANNING &ZONING Reviewedby:— Date: TREEADMIN. Second Review: ElApproved as revised. ElDenied.V PUBLICWORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date:— FIRE SERVICES Third Review: E]Approved as revised. E]Denied. Comments: Reviewed by: Date:— Rwised 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 Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@wab.us Date muted: lo�R Cityweb-site: http://�.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 1 �0(00 IxLail mJ . DgpadMent review required Yes No Applicant: tanning&Zoni gTre mstrator Project: UpkuCk ID-%bA- �e_nLla a ublic Utilities Public Safety Fire Services Dept Signature Other Agency Review or Permit Required Review or c R—onda Dept.of Environmental Protection of Permit Verifl=y Date Florida Dept.at Transportation -it.—Johns River Water Management District Amy Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: JrApproved. ElDenied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: 7 TREEADMIN. Second Review: EDApproved as revised. E]Denied, PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ElApproved as revised. DDenied. Comments: Reviewed by: Date: Revised 05114/09 City of Atlantic Beach APPLICATION NUMBER Building Department Cro be assigned by the Building Department.) 800 Seminole Road Atlantic Beach,Florida 32233-WI 7 -,at I o Phone(904)247-5826 Fax(90#g47-5845 E-mail: building-dept@mab.us Date muted: Cityweb-site: hfip://�.coalb.us APPLICATION REVIEW AND TRACKING FORM P ro pe rty Ad d ress: (0_D Uta iA Dglaaftnent review required Yes No (\" _ IN Applicant: -Planning &Zon ��o Project: K-P-nLO 2�t imsM tor WkA Zplllw�s;� Flublic Utilities�) Public Safety 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 Cc"of Engineers D,vis f aMlRosl2urants ,�is on of Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: VA�pproved. E]Denied. (Circle one.) Comments; _Q1 BUILDING PLANNING&ZONING Reviewed by: Date:zzho�_ TREEADMIN. Second Review: E]Approved as revised. E]DZied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: —Date: FIRE SERVICES Third Review: ElApproved as revised. E]Denied. Comments: Reviewed by: —Date: R.Ased 05/14109 City of Atlantic Beach -oz�: , APPLICATION NUMBER Building Department Cro be assigned by the Building Department.) 800 Seminole Road FEB 6 Atlantic Beach, Florida 32233�544 it ? Phone(904)247-5826 - Fax(904k47-5845 Date muted: CQ I o(0 1 Do E-mail: building-dept@wab.us Cityweb-site: hUpW�.coalb.us APPLICATION REVIEW AND TRACKING FORM Property Address: I P1 QQ-0 DUaA DilipartMent review required Yes No Applicant: 0 C-Planning&Zon! Tr nistrator Project: AMLLk J�ilxlu (-Public Utilities) Public Safety Fire Services &yiew fee I Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified By Date Florida Dept,of Environmental Protection R-o-nda Dept.of Transportation St.Johns River Water Management District Amy Corps of Engineers Division of Hotels and Restaurants -6ivaon of Alcoholic Beverages and Tobacco Other: APPLI�ATION STATUS Reviewing Department First Review: Vpproved. []Denied. (Circle one.) Comments: BUILDING A11A PLANNING 8,ZONING Reviewed by: DaW TREEADMIN. Second Review: [:]Approved as revised. nD,nid. 'LZ �WORKS/ Comments: UBZIC UTI ITI PUB?IjSAF9 Reviewed by: Date* FIRE SERVICES Third Review: DApproved as revised. DDenied. Comments: Reviewed by: Date: Revised 05/14/09 I PAID BuILDING PERMIT APPLICATION 7�T__Clbl — CITY OF ATLANTIC BEACH DATE 800 Seminole Road,Atlantic Beach Fl,32233 OFFICE COPY Office:(904)247-5826 - Fax:(904)247-5845 JobAddress: 13(l) oc-� Blvd. 441�4�� 13—k ;% 3Q.733 P�mitNMber: 1 '9-F-(JC6- �319_b Legal Description I.-i' &-k 04AAAk 0,f*h� Valuation of Work(Replacement Cost)$_*L0_0 _Hented/Cooled SF_Non-Heated/Cooled • Class of Work(Circle one): e Addition Alteration Repair Move Demo Pool Window/Door • Use of existi ulmd" (Circle one): Conumercial Zes=d-Im • If an existing structure,is afire sprinkler system installed?(Circle one): yes <� N/A • Submit a Tree Removal Permit Application if my trees ane to be removed or Affidavit o Describe in detail the type of work to be performed: kr,'�� 0[&_ '__q_ N--"l 10:'�4 e,4�e,s Florida Product Approval# for multiple products use product approval fiam, Property Owner Information Name: T.,�rA A ,il,a:J,L`K Address: 1,?40 Ae:e5o C City StateFGZip, :Z3 3 Phone oq- o6- 271 it' -cs`� E-Ma�il 'I (7Z;We_4_rWgent (nAalimysr�uffiatorneymAgenryl,encrReq 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 Company: Qualif�ing Agent: Address: City— State Zip Office Phone Job Site/Contact Number State Certification/Registration# E-Mail Architect Name&Phone# Engineer's Name&Phone# Worker's Compensation c"'on s twoby s uauce _�s _.a is F Ap' 'a'he Wh-pi's"' ls�'o%s- Sg-s 'Its S gas of Prpe B to am t -sl';:Day of h "nd this application and know 11 be compiled with whether s provisions a Notary Public:: &, f Y a he Notary Public: "N JOHNSTON 4PR"AWk,.r 2ined this application and know the same to be true and"u'rrect. Allprovisiom oflaws and V. to, vill be complied with whether spec d herein or not. The grantinit of a permit does not L M ncel the provisions of any otherf2least, state, or local law regulating construction or the gaaaaw up" rim OFFICE GOR CITY OF ATLANTIC BEACH OWNER/ ]BUILDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 KGONSTRUCTION CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW. DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSE CONTRACTORS. YOU HAVE APPLIED FOR A REMIT UNDER AN EXEMPTION TO T LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU US SUPERVISE T14B CONSTRUCTION YOURSELF. YOU MAYBUILD OR IMPROVE A ONE-OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COM�IERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING AUSLRE-EQRYQ-URUSE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WIRCH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDREJ TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYEE) BY YOU HAVE LICENSES REOUIRED By STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. NS13D T LI7 TB]A 14 1 TO ACT AS OU MUST IL INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. Ill. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(l). AN-OCCUPATIONAL LICENSE-IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY 'CERTIFICATE OF COMPETENCY' OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826)IF IN DOUBT. V.ACKNOWLEDGEMENT;I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WTH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. J-?b'O oc�� 2? - AI)DRESS PRIWT N�A GNAW DATE d1dy 20 1'11.M...�tl of NoW�PuNmtd�me,S�d CountyW P.�ty ol�"'GO(AN$N. EXPIRES�wv-m Not.,Signawm ".:.1 X, NOTICE OF COMMENCEMENT state of FL County of Qmucj 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 stated in this NOTICE OF CONEVIENC LegalDescription oflitoperty being improved: L.4 RWk S:!J, Address oflamperty being improved: ) 3eo occ"' General description offinprovements: hy" V�f'j ""Cry A 13160 CC za� —:r 4site ofthe improvement tA� wn :s i.H.,�Wsfte of a�.,rv.-Iat Naa Simple Titleholder(if other thati owner): Name:—T..,'.5 ,,'L jc�v Contractor: r Address: Telephone No.: Feat No: Surety(if aray) Address: Amount of Bond$ Telephone No: Fax No: Name and address of my person maldng a loan for the construction ofthe improvements Name: Address: Phone No: Fact No: Name of person widim the State of Florida, other it=himself, designated by owner upon whom noticas or other documents may be served: Name: Address: Telephone No: FmNo: In addition to himseli, 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): TMS SPACE FOR RECORDER5S USE ONLY OW 'jNjrE'R d Doc#2017036M�OR SK 17878 Page 1086, day o t. A, in th all State a this Nunat,er Pages:I r, this yo idx has vecsonxtly� appeared Recorded OW 6/2017 at 09:14 AM. I ridahaspersonallyappeared Wyf# (AX- —hock Ronnie Fmsaell CLERK CIRCUIT COURT DUVAL Personally Knoorn Or COUNTY Prod=d Identification: RECORDING SIO.00 Notary P�bh,: 'AIN V,,, slo%#GG042964 W Co EXPIRES. 2T.20" N"Wu� 4-k 'fe O-DEI-J The Law Offices of Rod Schloth 2187 S Third St Jacksonville Bch, FL 32250 It 904-372-9351 beach@rod-taw.com PROPERTY ADDRESS, 13WOCEAN BOULEVARD ATIUANTICBEACh FLORIDAM233 SUWEY NUMBER:R-1604.2007 mmmmm=� FIELD WORK DATE:VI&Mn6 RWISION DATE(S):(RIP41 1�1, e,V, R 1604.2007 TABLE� 6OUMARYSURIVEY L 1 5 7,001 E 100.00,(P) DUVAL COUNTY 5 7�00i E 100.03-(M) No ji� S 5,C. LOT 5 ELK 54 LOT G DUK 5 11,n? P.B. 15, PG. 83 1124.9 1-(M) N P3..C2.1 543 JS 15T,. LOT 4 BILK 54 LOT 4 15LK 5 ...... 54,13 P.B. 15, rG. 83 in cn 00 OU 2 ID 0�g Opp 2 1 (M) La Re-rip 58 CqlG'W 0 NO 10 0 LOT 3 LOT 3 BUK 5 BUK 54 F.E. 15, PG, 83 15 30 h"i Mat this Bondery Szwy offfis harew nade .y dinaaam,and Ic be best of.,kneeadge adbiesf ills a andissi nisneensdisn, N 0`8 su"y del PRi the Slandards&Pactce set"bybis F)nnda BoandapIviessi GRAPIEC SCALE (in Feet) I inch 30' ft. m y ane y A"i a R Be y L nA d in s As FLOOD INFORMI POINTS OF INTERE',- BY PERFORMI=A SEARCH WITH THE LOCAL GOVERNING NONEVISIBLE MUN C1 CIPAUWOR%WM.FEMi THE PROPERTYAPPEARS TO BE ' P UW L L '0 ICATCD IN ZONE X.THIS PROPERTYWAS FOUND IN THE CITY OF A'TLA TIC C TI-ANTIC BEACH,COMMUNITY NUMBER 1M75,DATED M3/13. BEA P D G Ea E "0 N IRS To BE 0 CITY OF M"'3 IN N TS E0 VIEF I BI argm Pefitt-Ewan & Tom Guhhon 'U' T M .. REALTOR-0 CLIENT NUMBER�RS1&3702 DATE:4/1�016 Margi:904.571.9821 U Tom: 904.566.6501 "Y" 'AM ,A BUYER:JAMES ANDREW SHI Is SARA MCILAUGHUN SHOCKLEY wwmargiandtomselIju.mm "LL , , PAR Ai B...-.,.,--..�=mast.netltlbiggonglive.com SELLER-SARAH ALIN THOMPSON CERTIFIED TO:JAMES ANDR2N SHOCKLEY&SARA MO-AU GHLIN Z SHOCKLEY;TIFF LAW OFFICES OF ROD SCHLOTH,P.A.;OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY,CASH EXACTA in'. Land Surveyors, Inc. This is page I of 2 and Is not wild withata all IF 1916-F 866 74�288? i,jye,FL33913 liftSub,14t A