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2014 VELA NORTE CIR - DECK ,� r J J . �' --'•\ , CITY OF ATLANTIC BEACH . - �� 800 SEMINOLE ROAD `J ATLANTIC BEACH, FL 32233 \. ' __Y: INSPECTION PHONE LINE 247-5814 RESIDENTIAL ALT/OTHER MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 17-DECK-3824 Job Type: DECK/PATIO Description: remove wooden deck and replace with pavers & add walkway Estimated Value: $12,000.00 Issue Date: 5/4/2017 Expiration Date: 10/31/2017 PROPERTY ADDRESS: Address: 2014 VELA NORTE CIR RE Number: 169506-1.046 PROPERTY OWNER: Name: FERGUSON, THOMAS W Address: 2014 VELA NORTE CIR GENERAL CONTRACTOR INFORMATION: Name: KETTELL INC. Kyle Kettell, N/A Address: 1860 MAYPORT RD Phone: 904-372-7226 PERMIT INFORMATION: PUBLIC WORKS: Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line (247-5814) to request an inspection from Public Works for Erosion and Sediment Control Inspection prior to start of construction. All runoff must remain on-site during construction. Roll off container company must be on City approved list (Advanced Disposal, Realco Recycling, Shapell's Inc.). Container cannot be placed on City right-of-way. Full right-of-way restoration, including sod, is required. Any plan change must be submitted as a Revision to the Building Department. FEES: PLAN CHECK FEES $55.00 BUILDING PERMIT FEE $110.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. t � ,,, ,_J.\_,\/:,--:, CITY OF ATLANTIC BEACH ;� ;; 800 SEMINOLE ROAD J V ;: ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 -`.4:-.)1319 STATE DBPR SURCHARGE $2.00 STATE DCA SURCHARGE $2.00 Total Payments: $169.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC REACH ORDINANCES AND TIIE FLORIDA BUILDING CODES. (---sL, , City of Atlantic Beach APPLICATION NUMBER -=. ' ` Building Department (To be assigned by the Building Department.) . '2 800 Seminole Road G 1 '7.. • '.-----) Atlantic Beach, Florida 32233-5445 lq— DEL�� 3 oa l I '1 Phone(904)247-5826 • Fax(904) 247-5845 %-'!o;;ic.. O:- E-mail: building-dept@coab.us Date routed: I it-,,S- -S I 1-9-- City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: a 0 t Lk \J au Notk L Com.i c,« Department review required Yes No Building Applicant: ‘Q.-it t_kk 1 C. I nnin &Zonin Tree Administrator Project: (t,MuJ,L t,-)OO61,/.-(1 (Pit 4--f L{ ,C6..LPPublic Works •.J .- �2( E i� c S `4 (AAA.w ct�kwa `Public Utilitie 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 V Reviewing Department First Review: W1Approved. ❑Denied. (Circle one.) Comments: BUILDING '/ PLANNING & ZONING Reviewed by:4 C/A— - Date: //0f( 7 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 05/14/09 i�Li;.,�, City of Atlantic Beach iicAPPLICATION NUMBER ,r • J s� Building Department (To be assigned by the Building Department.) 800 Seminole Road J� - �� 2017 I/4-0Ec t - gay Atlantic Beach, Florida 32233- 5 APR .2 3 Phone(904)247-5826 • Fax I4)247-5845 \U;9J9r E-mail: building dept@coab.u1`'_ __ Date routed: IN I a-S 119"- ____! City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: a 0 1 (4 v Lka. NOfk CI r at Department review required Yes No Building Applicant: ,e-i-\- LIA l C. 4 j-nnin• &Zonin. Tree Administrator Project: f t v\uu,L t.)O O6,Ln JUL #f L.Q J&L�. Public Works W .-1 h p0.0� S `- add..W ot,VV—Wa Public Utilitie �(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: (proved. °Denied. (Circle one.) Comments: --ie i 6r_,y4 BUILDING ��GG ^,� PLANNING &ZONING , Reviewed by Date: !,�/ I7/40 17 TREE ADMIN. Second Review: A roved as revised. ❑ pp ['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 i�L City of Atlantic Beach APPLICATION NUMBER t-5'r :4 Building Department flECEVE (To be assigned by the Building Department.) t 800 Seminole Road I��V ` 3 ��` r �� Atlantic Beach, Florida 32233-5 5 APR 2 5 2017 h `f \ Phone(904)247-5826 • Fax(904)247-5845 .6 i-vi? E-mail: building-dept@coab.us • Date routed: 0 { I a-S I i+ City web-site: http://www.coab.us"- APPLICATION REVIEW AND TRACKING FORM Property Address: a o t k l au NOR ft_ C,i,i c . Department review required Yes No Building Applicant: KLkk L\A k �-,r\C. 4 '1.11M, • : • Tree Admits rator Project: (tt\uu„L. %..)OO.1.n Jai 4-r�QUt(j 4 Public Works W k-1 h pa'J� S A- (AAA-W CO -W49 Public Utilitie t Public Safety Fire Services Review fee $ f Dept Signature ,-ti- 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: proved. ❑Denied. (Circle one.) Comments: n J BUILDING '" fr PLANNING &ZONING Reviewed by: / )1i Date: 2> ? TREE ADMIN. Second Review: Approved as revised. ❑Denied. P.:f WO7 Comments: 'UBL C UTILITIES PU LIC SAFETYReviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 C:" in ov9---1 �n BUILDING PERMIT APPLICATION '..-/ il 04 , ",,�' APA 2 1 ,, ;, '- � s CITY OF ATLANTIC BEACH DQE i 800 Seminole Road,Atlantic Beach FL 32233 _._. _____i d'.-to,3)>>' Office:(904)247-5826 • Fax:(904)247-5845 i Job Address: Z)I'W. VQ/L /00f f e_ (1(tzt/ _ Permit Number: 11-0 LC.k-3 9y Legal Description 3q-q1 Qq-ZS'2g e £i,..,4,1,,,....3 1 1 r13 RE#- 1645-0 6 - 014 Valuation of Work(Replacement Cost)$ I L r 000 Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New Additio Alteratio r Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial 'esidenti. • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No 4g60 • 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: Poryyre. deck. a-nd Per%LL G.0-1, $ ,- d Florida Product Approval# for multiple products use product approval form Property Owner Information '' II Name: I ►Dr�+a 5 �u�use) Address: 7.01 tiVe4 /l. fe Ca re LI- City 44p,,�ft C e'o G,. State FL Zip 37,2 33 Phone 7a.- 31/4/i 79e t E-Mail I.c 4ti too(coa+ (- A rui tt • (Aryl Owner or Agent (If Agent,Power of Attorney or Agency Letter Required) 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 NOTIdE OF COMMENCEMENT. Contractor Information: ��II- l Name of Company: 1'IL/ /t 1//� D�c- Qualifying Agent: ) 611.-- L Address: (3t) + Raid City . tin t&net State Zip re 3Z Z 33 Office Phone got/ 17,uo Job Site/Contact Number `NA It - gal 377 /odg State Certification/Registration# E-Mail ;n•re Q �iv 1t,J/inc . GDS"-, Architect Name &Phone# Engineer's Name &Phone# Worker's Compensation On Ale, Exempt / Insurer / Lease Employees / Expiration Date Application is hereby made to obtain a permit to do the work and installations as indicated. I cert fy 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. becomes null and void i work is not commenced within six 6 months, ori construction or work rs suspended or abandoned or a —11:11i; (6)months at any time of er work is commenced. I understand that separate permits must be secured for Electrical Work,Pluming, Pools,Furnaces,Boilers,Healers, Tanks and Air Conditioners,etc '<)$g fLi of Property Owner: Signature of Contractor: , / /�'/1�/4/ R2Befo•e c1 t�4h1tl� Day of 1\ \ I ay D I ' - Before me this 71 Day of 4/ n x n L _ e A ;2 , ublic: Notary Public: �,� .ter._ Ali o,_ V z , -1 ►` l erty that 1 have read and examined this application and know the same to iptroe c1 col., 4914.14114 4s of 1.1 tis and NI s governing this type ofwork will be complied with whether specified her: r1, �t..,cr(;: 11id't ,#F� t es not tt me o give authority to violte or cancel the provisions of any other federal, st, -<;.y' ,W l( ES t ec2lrO' ctio` or the )er orm ce of construction. i ''oeo�'�oS`' Bonded Thru Notary Pubic Underwriters J J' / I, t L MAP SHOWING SURVEY OF LOT 23, SELVA NORTE' UNIT ONE, AS RECORDED IN PLAT BOOK 39, PAGES 94, 94A AND 94B OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. • F0/4: /-/EA//4Y ,FEEL. ''f? I L o /8 I Lor I to A/00 0 •p E I :3 5° _ N _ FouNO i"/�5� - S'", (oY-s 3398) SO'ORA/A/AG. EE'IE ' QY,,V•47- 1)1 (.., � • ' P In Lv1 I 1 0 k41' 103 IO 3, ;// ,, .9• 2 \ h A /o. 31 6. 30.4' /O.Io' __.� ``T N p� `�" !7 ^4.45pn//vY FOII/VDA7'/0n1 • t,u Vki /'� •yc BLOCK Et E.!(/?•07) \ 3 /5-cf 4,,,t-.i � N n 9/5 P e6,/,././-14 "C„, . m //.7 %4• •� F 7,./.1% • CiotbefaAe- ,.. rn tt, `-----i--_________� B360' wCs •3398) ( - .:/Ra...• S.O/•2/'OB•'W. CAI• 9/.2G' R./32S• • 33 98> VEL 4 AOR TE C/RCL E SO .c:',../ •7"M/5 /5 A esoUNOARY 8uR✓EY •N0 3u'L04,/6 KE5TR/CT/oN L Ave QY PLAT. •77./5 PRdE47Y 4/45/A/ FL000 ZONE' -8' W.41aN/5 QETN/EEN 77/E /00 YEAR 4,vo Sao YEAR .hOoo AREAS. • ELE✓ATroNS 5NOWN T//4/51//2.07) AIA/0 REFER TV NATMNAL aEo 7-,c YEW TICAL OATUM. I hereby certify that this survey meets the minimum technical standards as set forth by the Florida Board of Lard Surveyors,pursuant lr N. A. DURDEN 11472 .0? Florida Sta tes. & ASSOCIATES INC °�� LAND-- SURVEYORS SIGNED -OSCE/cldER 2U gyp_ Poet Office Box 50870 830 Beach Boulevard SCALE: /" -,G Jacksonville Beath,Florida 32250 THIS SURVEY NOT VALID UNLESS THIS PRINT IS EMBOSSED WITH THE SEAL OF THE ABOVE SIGNED. /3.13 D/ 144 46d"TfZy IV itigyo Xzy = Piz Awe1��{3f''/a K f _W littfr 41A _ efoZ 417- - < _ , . ProPuc� .",f%o,. ffi 6uf - 1 Y7? gla % 6Y- 3 Ail( if.r °moo .i.LTJj4., :is r#440S, C13 1.1y omp. By: SRW s Date: 4/26/2017 a Public Works Department City of Atlantic Beach Permit No: 17-DECK-3824 Address: 2014 Vila Norte Circle Required Storage Volume Criteria: Section 24-66 of the City of Atlantic Beach's Zoning,Subdivsion, and Land Development Regulations requires that the difference between the pre-and postdevelopment volume of stormwawter runoff be stored on site. Volume of Runoff is defined as follows: V=CAR/12 Where: V=Volume of Runoff C=Coefficient of Runoff A=Area of lot in square feet R=25-yr/24-hr rainfall depth(9.3-inches for Atlantic Beach) Predevelopment Runoff Volume: Lot Area(A) = 15,240 ft2 Runoff Coefficient Area Lot Area Description (ft2) (ft) "C" Wtd"C" Impervious 3,213 15,240 1.00 0.21 Pervious 12,027 15,240 0.20 0.16 Runoff Coefficient(C)= 0.37 Runoff Volume V= 0.37 x 15,240 x 9.3 / 12 V= 4,354 ft3 1 Postdevelopment Runoff Volume: Lot Area(A) = 15,240 ft2 Runoff Coefficient Area Lot Area Description (ft2) (ft2) "C" Wtd "C" Impervious 3,875 15,240 1.00 0.25 %ISA= 25.4% Pervious 11,365 15,240 0.20 0.15 Runoff Coefficient(C)= 0.40 Runoff Volume V= 0.40 x 15,240 x 9.3 / 12 V= 4,765 ft3 11 Required Storage Volume DV= Postdevelopment Runoff Volume-Predevelopment Runoff Volume DV= 4,765 - 4,354 0 DV= 410 ft3 0 0 Retention MASTER WATER RETENTION 4/26/2017 ;; t ;,-�Comp. By: SRW ? Date: 4/26/2017 .--rH 9....) Public Works Department City of Atlantic Beach Permit No: 17-DECK-3824 Address: 2014 Vila Norte Circle Provided Storage: Elevation Area Storage (ft) ft2 ((ft3) 4 ? 9.5 144 0BOTTOM 12X12 ? 10.0 196 85 TOB 14 X 14 Elevation Area Storage (ft) (ft) (ft3) 0 BOTTOM o TOB Elevation Area Storage (ft) (ft2) (ft3) 0 BOTTOM 0 TOB Inground storage=A*d`pf A=Area= 196.0 d=depth to ESHWT= 6.5 pf=pore factor= 0.3 Inground Storage= 382.2 ft3 Required Treatment Volume= 410 ft3 Supplied Treatment Volume= 467 ft3 Retention MASTER WATER RETENTION 4/26/2017 ".11Mr- 8S-o Z S-Es#44 '7 14 Ue ;tie Bim. s Y-rc?6-1 N m T..e/ R*' 0 OP ti 10 I. N CO I n f..-• 9.7o- 68 0" I,/4 . 1 I o LN l kat; .9'/•2G' S',TN. Cy vG 22- 1.7, 0 N/e ."1 A_i Z-7 d C i/2-• LoT •3 S EL..9 ".,/c,,,ILTE UN/ r 4Ne- V so �vv�1G Co/ f-'S'• rp`,Ft0`1,,gfs C�`� r G p ,r o.� OECD 4 ''3aj .max.,cc. Ar.4 ,vL9A-' A .24 PAs• 39//'6• a B /a-=•G-da f7/•,CcdtE2 � EI Vr[ II I �,- ` , BUILDING PERMIT4 t �s r, ,• APPLICATION D E ::; J CITY OF ATLANTIC BEACH APR 2 lD E �r V 800 Seminole Road,Atlantic Beach FL 32233 �%' �"��;3i>�° Office:(904)247-5826 • Fax:(904)247-5845 Job Address: Z )/ 4( 144 /064-t_ ()r at_ Permit Number: t' - Legal Description 3a-atf 0q_15-211 e ,,q •6__0,3.1 krL3RE# /645-0G r /0£I Valuation of Work(Replacement Cost)$ I L, 000 Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New Additio Alteratio Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial ;esidenti. • If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No /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: ;L 4,004 d€ck. u.nd rep%Le_ i,.4 Ovv d- 44N 14.kt.r Florida Product Approval# for multiple products use product approval form Property Owner Information Name: I tsy,- 5rAvse,-- Address: 2-0I LI \J&k / fe_ C t City 4 -hl era,G,, State FL Zip 3i7-33 Phone .765 31/4/ 79dt E-Mail t,e(,(L too(co)•F 62- et pui;l . tini Owner or Agent (If Agent,Power of Attorney or Agency Letter Required) 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: )10/144( �il-)L Qualifying Agent: )"%*- `. Address: 186f) i- Roa c'( City 71/ n,1 State Zip t'`- 3L Z 33 Office Phone '/,t/r 7 Z. 7 z Z.6 Job Site/Contact Number le- - qcy 317 Mg State Certification/Registration# E-Mail in 4 t glitte,b 11c . aw,-, Architect Name&Phone# - Engineer's Name&Phone# Worker's Compensation Or\ rile_ Exempt / Insurer / Lease Employees / Expiration Date Application is hereby made to obtain a permit to do the work and installations as indicated. I cerci'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. becomes null and void if work is not commenced within six(6) months, or if construction or work is suspended or abandoned or a p;,t, (6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Pluming, l-- Irv.,4s,_f ,Pools,Furnaces,Boilers,Heaters,Tanks and Air Conditioners,etc "9 'tu 1- of Property Owner`z�� (� , ��e foie � e P rh' Signature of Contractor: ,- -/`�/��/, tDay of 4 f1 k ` 2rD I 'l- Before me this Z'/ Day of ,t/ 0 ;50`11 Z 14175, •ublic: Notary Public: % �' "www. k°oz I MN ititp-er#i esti that I have read and examined this application and know the same tot• 1 correc>1FN WS >I91IN i'Alls of1 vs and Mt 4 9 s governing this type ofwork will be complied with whether spec(ft'ed her: Vii# ,.o{'t TN�tg ► r�O� �,c es not �t� mel o give authority to violte or cancel the provisions of any other federal, st.' ,- qs•✓ la,vtbet(d tROctno or the ger ortn, ce of construction. 1 spR,�oP' Bonded Thr,Notary Pubic Underwriters MAP SHOWING SURVEY OF LOT 23, SELVA NORTE' UNIT ONE, AS RECORDED IN PLAT BOOK 39, PAGES 94, 94A AND 94B OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. F01Q: A/EA/RY /FEEL.EF? -1- PL 7 - I p 1 I `'. L O T /6 I L 07- // • Ytn a I ti • A 00w04.40••E. i 85.00 FOL/NO 4--,A0....., ♦ ',•-•-,,,,,,,,,,./.-i.-•./Q�— (PL..5 -•3398) 6-z.s•'339G) 50'ORA/NAGE E45 1EA/7 BY a'AT Lai- (0 /s 21 5--- 11 AO �- ;Gt1a0 1111.yo /1/ 2 2 /O,3 310' 30.4• /0.l0- p N 0 M.450NA'Y FOL/NOA7'/On/ , 141 '"— "- V (CONC. &Lc-CK On/L Y) Ta'-qF BLOCK E[E✓. (,?.O7 l/ 3 /3-y L}_>i iN I -,5' p BVI ^ 1.? ( K1 CN ZG /0.5. V („70 (\I 0 m (r1, COUVIla9 /RaN ..**-4------------.— 83 eoO' /..-e s' '3398) `\��. �s—X335•) S.O/•2/'08-1.4 C.V.' 9/.2. R-/3f2. ' VEL 4 A/ORTt C/RC L E so-,r,/,./ • TN/S /5 A GOUNOARY SURVEY •NO BU/LL7wcs RE57-R/CT/0N L/NE BY PLAT •77115 /.40oERTY UES/.c./ FLAov ZCH/E -8' WA/1Cd//5 BETWEEN 771E 1.00 YEAR 4N0 Scan YEAR FLOot AREAS. • ELE✓A 7/0A/5 SNOW,, THUS,1/Z0 7..) ANO REFER Ito "4"1770N4 6E0.067-7C VERT/CAL OA TUM. I hereby certify that this survey meets the minimum technical standards as set forth by the Florida Board of Lard Surveyors,pursuant le N. A. DURDEN to Section 472.07 Florida Sta tes. & ASSOCIATES INC. • ..„4„,, � LAND wwurrwao auwvavow roc,/v 70eu. SURVEYORS Post Office Boo 50870 SIGNED •OECEa7dER 2[J li 8i 830 Beach Boulevard /'' 30• Jacksonville Beach,Florida 32250 SCALE: THIS SURVEY NOT VALID UNLESS THIS PRINT IS EMBOSSED WITH THE SEAL OF THE ABOVE SIGNED. /3'5 F3 • NOTICE OF COMMENCEMENT State of F/,(4 County of V,,,y ic ( 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 COMMENCEMENT. Legal Description of property being improved: 5q -q ii 0 q1-25-?A F- Soilva jafc vim- 1 1.4- 7 3 Address of property being improved: �/ �, f(i TZ �{ • General description of improvements: A_w o ' ,, A' R' it A/ , ' I., OW- — Owner: P 1hti , � (u5 or, Address: l j Owner's interest in site of the improvement: Fee Simple Titleholder(if other than owner): Name: 4Contractor: )4' j�l/ 2 -v Address: /ff t Mz 1 -� ' Add 1 .4W 11h gr,l�i P1 3 Z/ 33 Telephone No.: fel 3�Z 72.2(r 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 Signe Li, Date: L/^ 1 -- 10 Doc #201!uaLrnL,uR BK 17954 Page 2003, Before me this 1 S day f kQi 1 1 in the County of Duval,State Number Pages:1 Of Florida,has personally appeared be-V01-e_. in Recorded 04/21/2017 at 11:49 AM, Personally Known: or Ronnie Fussell CLERK CIRCUIT COURT DUVAL Produced Identification: • i0 Li` V.(.Lt 1 SL COUNTY Notary Public: ‘I_,,k; ''.• "f'_ RECORDING$10.00 My commission expi Q s: v ° ~,` • 1 ,, JENNIFER JOI NSTON ' '* a•, Z MY COMMISSION#GG 042984 ' I "' 4' EXPIRES:October 27,2020 stv ei ''y,,,o••ng^ Bonded Thru Notary Pubic Urderwrtters A W r_r WOW IA I A.. AI-'4