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1820 SHERRY DR - FENCE ` s ,iiit sA CITY OF ATLANTIC BEACH ) 800 SEMINOLE ROAD liv ~ ATLANTIC BEACH, FL 32233 '1"2.0;1 9% INSPECTION PHONE LINE 247-5814 FENCE WALL OR BARRIER - FENCE MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: FNCE17-0059 Description: replace 6-foot fence Estimated Value: 10270 Issue Date: 11/29/2017 Expiration Date: 5/28/2018 PROPERTY ADDRESS: Address: 1820 N SHERRY DR RE Number: 172020 0776 PROPERTY OWNER: Name: YOUNG SARAH L Address: 1820 SHERRY DR N ATLANTIC BEACH, FL 32233 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: Address: Phone: PERMIT INFORMATION: Please see attached conditions of approval. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. * A notice of Commencement is only required for work exceeding an estimated value of $2,500. For HVAC work, a Notice of Commencement is only required when HVAC work exceeds and estimated value of$7,500. ../LAIJ;. City of Atlantic Beach APPLICATION NUMBER �s sl Building Department (To be assigned by the Building Department.) r - - 800 Seminole Roadnip •r�L 2 ;r Atlantic Beach, Florida 32233-5445 f i' w ( 7 —O M- Phone(904)247 5826 Fax(904)247 5845 i.4-e-0-4- City / -A*at yr E-mail: building-dept@coab.us Date routed: OI I �e-1(-4- City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: I $act N she,ay Otr. De artment review required Yes�No Building I/ Applicant: ©wn x.�t Planning &Zoninig> Tree Administrator Project: (aptCC/- b--.FOD 1- -Pttl(k_ Public Wor C_I_Dublic 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: APPLICATION STATUS Reviewing Department First Review: QApproved. ❑Denied. ❑Not applicable (Circle one.) Comments: BUILD! PLANNING &ZONING /M .df.17 Reviewed by: / / n Date: / TREE ADMIN. Second Review: Approved as revised. Denied ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 ZONING REVIEW COMMENTS f fry ` ;t City of Atlantic Beach Community Development Department 800 Seminole Road Atlantic Beach,Florida 32233-5445 t r.Date: 9/27/2017 Permit: FNCE 17-0059 Applicant: Sarah Young Review: ZONING Address: 1820 N. Sherry Drive Site Address: 1820 N SHERRY DR Phone: 904-868-2377 RE#: 172020 0776 Email: sallycliftonrd@gmail.com Correction Comments Fence Height: Selva Marina Unit 10B Covenants and Restrictions require maximum fence heights of four feet. Please revise accordingly. Informational Comments Brian Broedell Planner 0.1..AP f%, City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 'v 800 Seminole Road ,� L �j 0 Atlantic Beach, Florida 32233-5445 FA t�w 1'-OV I- Phone (904)247-5826 Fax(904)247-5845 013i9-firE-mail: building-dept@coab.us Date routed: 011a (r4- City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: I ICAO N . she,i°(y o(• _Department review required Yes No Building Applicant: 0 wn a Pla`nnin• &Zonin. r,' fb,,- Tree Administrator '(U Project: Pl Ct t F=o0 % �e n L Public Wor Public 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: APPLICATION STATUS Reviewing Department First Review: ❑Approved. Denied. ❑Not applicable (Circle one.) Comments:MGX L7 1 f� le y��, 1y Se/v1 /14<<^., 100 pvte f BUILDING PLANNING &ZONING Reviewed Date: C'—Z7-17 TREE ADMIN. Second Review:)Approved as revised. [Denied. ONot applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: v /� Date: /t FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. [Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 s CITY OF ATLANTIC BEACH `� 800 Seminole Road 1 '" Atlantic Beach,Florida 32233 REVISION REQUEST /CORRECTIONS TO PLAN REVIEW COMMENTS Date Revision to Permit Corrections to Comments V Permit# FN C6I' -ODS-5 Project Address 1 ' 0 N . Sherry pf.\J9_ Contractor/Contact Name bw SCq cl h tai Phone 9 0 - TO t'— a:191- Email Description of Proposed Revision/Corrections: Revision Review Fee Due $ V--.6N-_e v ,\\ ._ 1\o \.e._, tea„ 2.0c-A- c-,/y,,.r, ccoy\-1 v to ri'\y \, . Additional Increase in Building Value $ Additional S.F. By signing below,I affirm the Revision is inclusive of the proposed changes. (printed name) Signature of Contractor/Agent(Contractor must sign if increase in valuation) Date (Office Use Only) Approved X Denied Not Applicable to Department Revision/Plan Review Comments Department Review Required: ��z�2� C� Building Planning & Zoning Reviewed By Tree Administrator Public Works Public Utilities //IV/7 Public Safety Date Fire Services �ty�c- City of Atlantic Beach APPLICATION NUMBER Js. Pkit Building Department (To be assigned by the Building Department.) . 800 Seminole Road Fi rrL Irk_O w �� Atlantic Beach, Florida 32233-5445 (V l�C. I l Phone (904)247-5826 • Fax(904)247-5845 q / �p <�;.19'' E-mail: building-dept@coab.us SEP 25 2ir7 Date routed: o L I ����"� City web-site: http://www.coab.us •7 APPLICATION REVIEW AND TRACKING FORM Property Address: I ICAC N . She'(y AC. Department review required Yes No Building Applicant: © W n L Planning &Zoning> Tree Administrator Project: (0-fit LL b-1 ou - -Ptnk_ Public Worl Public 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: APPLICATION STATUS Reviewing Department First Review: 'Approved. QDenied. I Not applicable (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by: Date:,'V' 2 "/7 TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ❑Not applicable 11 PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ElDenied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 �,s�Lvr, City of Atlantic Beach APPLICATION NUMBER JS. �� Building Department (To be assigned by the Building Department.) -. W:-i ,2 i 800 Seminole Road -r CL ,� �.. Atlantic Beach, Florida 32233-5445 ��CC�p qq �(v w v. Phone (904)247-5826 - Fax(904)2474245 5 �p�� - tea;.•. q 11 �!,;319/ E-mail: building-dept@coab.us Date routed: 0 ` da"WI" City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: I ICAO PJ . S eA(y or. Department review required Yes No Building Applicant: 0(A)CI a Planning &Zoning Tree Administrator Project: (0-p t (LL b—,Ft)c) 1- -PALLPublic Wor _ 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 Reviewing Department First Review: I lApproved. '1�✓"Denied. I INot applicable (Circle one.) Comments: BUILDING / PLANNING &ZONING t✓ 1-`------- e//� 1 /r? Reviewed by: Date: TREE ADMIN. Second Review: Approved as revised. ❑Denied. Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Y=7,76.------ V 4,-------- Date: /b/it 7 FIRE SERVICES Third Review: Approved as revised. Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 rr1J�1J,.. _ �?� CITY OF ATLANTIC BEACH --It. OCT 03 ' 800 Seminole Road \r Atlantic Beach,Florida 32233 �Ji:1>r' REVISION REQUEST / CORRECTIONS TO PLAN REVIEW COMMENTS Date OC,}-, \ 121)\-1-Revision to Issued Permit Corrections to Comments Permit# "FNC E-f} -MSc) Project Address V?)ZCD S61 be. \y ,,n c c 1 F L (222-33 Contractor/Contact Name f01\ _, \ 6 lUtAA Phone 6.01-\ %18.-2:15-11- Email a\\\\S 30 TA@ Mai\ •(-0(n Description of Proposed Revision/Corrections: Permit Fee Due $ (X tis oc(APYAcc-c •[ VNA\-" ?et-TM\- , \oe,\1) o ,+Vc COC C s-w.e-r \\ eo.sc0.2r\-4- o A \4-\- t,a ¶ stib.e_ o- a c k _.& 6-U6ck a A-0 a\�vva -}t \r,L&� 'l c\ cQ C o.\o tea- ea e_ o- nus i c k \ e ‘c C-e. -I ra\- uer Additional Increase in Building Value $ Additional S.F. N) old.. l~t By signing below,I So,r CAN. \tOU ( affirm the Revision is inclusive of the proposed changes. (p ��'nted nam Ai /-1! — /0 -1 - l7-- Signature o Cont1-ctor/,- gent(Co,tor for must sign if increase in valuation) Date (Office Use Only) Approved / Denied Not Applicable to Department Revision/Plan Review Comments Department Review Required: `" _ Building Planning & Zoning Reviewed By Tree Administrator Pubic utiliti (p 3) ( -7 Public Safety ate Fire Services r • ice'''. Building Permit Application Updated5/5/17 City of Atlantic Beach OFFICE CC 2 S minole Road, Atlantic Beach, FL 32233 SEP 2 2017 Phone: (904) 247-5826 Fax: (904) 247-5845 Job Address: 1$7_1::) Shoe Y- '_ NcAVc_ 2Necsh\FL 3221 3 Permit Number: r JC( — 0°5'5 Legal Description \N e_. RE# Valuation of Work(Replacement Cost)$ t0)2- -t Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial Kfie-sidentia • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes NoN�/A • SubmitTree Removal Permit Application if anytrees are to be removed or Affidavit of No Tree Removal a e pp Describe in detail the type of work to be performed: CA ctarUve.d. a t\a. i\r/A,a c-e__beams \t\ W1t-a. O�rfam\, . 1S [A--rs,acs v ra,`cmc aF promsc\. . \\ ra \0tornskreN1V.6.. (4. exc 5,d v,;,l\�e� I T •t���,c.(. \�r.��v.�,�\ let. �`�� An,, �c. ya4t c S `,r�$1 off\ o e bCt\h SS S. �$-ce-h,gti.,,c(4led S'✓+.Le Florida Product Approval# for multiple products use product approval form Property Owner Information Name: 2k(w‘\ y'L)'1'%$\ � „\\ Address: 19,2-0 aL - -(pf. ►� City At 3ctic State F L_ Zip 32233 Ph e .90►1-810$-'?.?}-3-- E-Mail \`�C�Ar i\f A _"v \\ Core\ Owner or Agent(If Agent, Power�f Attorney or Agency Letter Required) Contractor Information •Name of Company: -: ,•ualifying Agent: Address , ' ° .•. City ''tate �.b Zip 'r!' Office Phone 1�•�L sJ( Job Site/Contact Num r State Certification/Registration# E-Mail L. 4. • - Architect Name& Phone# Engineer's Name& Phone# Workers Compensation 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 prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS, and AIR CONDITIONERS,etc. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. 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. (Signa e • ner or Age - (Signature of Contractor) including contractor) Signed and sworn to(or affirmed) before me thisa' - day of Signed and sworn to(or affirmed) before me this day of SQ0Q4 -(, WA- , by S L(c. 'AA , by " L � A na - (Signature of Notary) K` �•, " JENNIFER JOHNSTON MY COMMISSION#GG 042984 : Bonded Thru Notarylober Public Underwriters 27,2020 [ ]Personally Known OR "•`:. ] Personally Known OR .QProduced Identification ""'° CQ [ ] Produced Identification OA} Type of Identification: -1 A MU-fa—nom- Type of Identification: 51-t"Jr ej 4 % ) REVOCABLE ENCROACHMENT PERMIT THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of Oco Q( 20 by the City of Atlantic Beach,Florida,a municipal corporation organized and existing under the laws of the State of , Florida,hereinafter referred to as"CITY"and 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 for the purpose as described in the City of Atlantic Beach Right-of-Way Permit# This work is generally described asIA IXC N YIA\C. eQCh) F L 32.233 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 USER, said notice to USER shall be given by certified mail, return receipt requested,to the following address • 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." • 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 within 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 right-of-ways 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. AI L%L �r Date 10 '3--/4 Property Owner/Agent(s j e, in p - ence ofNo)s4iblic) STATE OF FLORIDA,COUNTY OF DUVAL The foregoing instrument was acknowledged this 3 day of 00_4-- 20 by n^f-akk (So(klOULy ,who personally appeared before me and (printed name of Si CSA(11) I ackn s-dged he/she sign d the ins ment voluntarily for the purpose expressed in it. De--- 4 ._, Signature of Notary Public, State of rida u+;Ii4ie5 Approved/Public W)ks Department: Personally Known Produced Identification(Type) P( IJ, L.tcesQ_ TQNIGINDLESPERCER ,, �/ ( 7 {� 4. MY COMMISSION#FF 924951 i 'j��y.•�" EXPIRES:October 6,2019 , L ed F;, 6;m ad 1'hra Notary Public Underxrfte s lie Moore,P P�Av'1 C U�Il��es 1)i eo ov `` RIGHT-OF-WAY / EASEMENT PERMIT °. " Permit # Issued by the City of Atlantic Beach i=NLt ti. - a)S PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES Job Address \ate Shy I- '�, CorkYko,MI —L_. Phone 8(0,60(4 - 2,3-39- Permittee rax 5A1. ` X33 JJ ��� Email k C', ‘ ,4 c. n 4 .ik k a Requesting Permission to Construct a . ` 64 Location(Reference to Cross-Street) ,,;. J , - - , y r` , , • , ti. eke s}.Ls- ue,A o.e 1441Si-. in • Permittee declares that prior to filing this application they have ascertained the location of all existing utilities, both aerial and underground and the accurate locations are shown on the sketches. h • Whenever necessary for the construction,repair,improvement,maintenance, safe and efficient operation, alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public Works, any or all said poles,wires,pipes,cables or other facilities and appurtenances authorized hereunder,shall be immediately removed from said street or easement or reset or relocated hereon as required by the Director of Public Works and at the expense of the Permittee unless reimbursement is authorized. • All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the supervision of (Project Superintendent) located at • All materials and equipment shall be subject to inspection by the Director of Public Works. • All city property shall be restored to its original condition as far as practical, in keeping with City specifications and the manner satisfactory to the City. • A sketch of plans covering details of this installation,as well as a copy of a recent survey shall be made a part of this permit. Calculations showing any increase in impervious area on owner's lot or in the City right-of-way are to be included with this application. • The permittee shall commence actual construction in good faith within days. If the beginning date is more than 60 days from date of permit approval then permittee must review the permit with the Director of Public Works to make sure no changes have occurred in the area that would affect the permitted construction. • It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right,title and interest in the land to be entered upon and used by the holder,and the holder will, at all times, assume all risk of and indemnify,defend and save harmless the City of Atlantic Beach from and against any and all loss, damage and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. • The Director of Public Works shall be notified twenty-four(24)hours prior to starting work and again immediately upon completion. Date /o -3 —17- Pe ittee(signed(prese o?No Public STATE OF FLORIDA,C TY OF DUVAL The foregoing instrument was acknowledged this ) day of ©Cip1e-er ,20 l-4— by .A I`Gl�... (Sj l \1O(„�,� �¢ ,who personally appeared before me and (printed n of Permitte ackn 1 -dged tithe/ he signed e instrument voluntarily for the purpose expressed in it. N Personally Known 2 L 0 L.- •.,.,w: Not. •. c, St Florida Produced Identification(Type) — V e,, TONIGINDLESPE ] MYCOMMISSION#FF924951 .:.•:EXPIRES:October 6,2019 °' Etnde9ThruN Notary Public Underwriters I -v 'A*!Jig /; i rio ' , OFFICE CO 9 y �; ir, x £68 S� I..U„:,, /t 0 . %• [V ro V' Pe ;C9 °d. pY e.. — � Building Department g7{{)�y/ j}f/��{�f)// '..A1JAJTV fid+ �• :t of t ti teen a/It 135 ,C6`99 M�tt ► I.0695; , 11 C 0 O£ I n{ n H„ -N . / ; -rf L 101/ 1 --r) y CO ) -r ,O-e ,i-z ,0 s 83 Vd-- q --z,..,......,\, c_.......„... , ..., _,___(_. . / ... tip ': , . i' lOCIN1Mi r Wit . . t I >. 't-- OZ81# t -L, D PI .. , ,o.zir ONIG-me _ ('` ' ', :• • :- 3A18 ` . wn. ,.. . • £ 313d3NOO • • • '• <. }. J r *.. 1 ON O ..)4,..'-".:. 1.-- d, 0.0 G 0 O NOdi .0.C£ £681#87 ,0'1.� „ZZ�01 y1113S :• --, COtl NO81 .&/1135 t . 77 - - __ SOO°49"26"E 100,002 _- t c) k w r s r!� r������ �filly �/A7�n? i��i ht '. CC allIt'lilill'jl Mil • _ 1 .0i 20.." 5.0' a> 183 25.6' c COVERED ' ) t,,,' , 13.0" "� U c 17.6' '.. co C Lo - �oot • o it Cwt 7,.. a.0� f °` �' � `° ' tom- . e . � � , i` 0` 13.8 23.9 � "f l'I''' .1000 addco 4x Q31N3G , , C 3AOdddV t _ lL OnenC.; SET 1/2" IRON ROD SL t 1/2" 0.0, , " 94. 2' .0' LB#7893 3U.0' . .. IRON RROD`B#7893 1' 18.E t 34.0' . .y •y i • :....'...;•.1,..! f• cp ' 'COCREET ••i•�... . `• } • . • " , � ''k ' *, I "3.0' ` DRIVE> . .fir BUILDING t, €2.0 I".�', • • < Al #1820 y `.!)+ •. • * 6 C-,-, .z r '. r, ♦r :i.-• Jf•.. ill CD ' « t .j La ? r•'i•: WOOD ce> , 7. ' 5 3 :?is. ,� c DECK. ' = ;►,:- ... J 32.3` `}} T "` •.'. fr. CTsi. ',� ,,,• i Cy i,. PAVE'?. 5:Q' 2.Q' 5.1' y j , 6.4' .y, ( � o C n c. 0 0 JA -a -' / V /+ r / _ - .,- C\ Q 30 yr �; , r•' «mss+' a ¢ IRON PIPE IROIV ROD--- )�I -. LB#78931 n 7 ly c-s NOTICE OF' COMMENCEMENT (PREPARE IN DUPLICATE) Permit No. Tax Folio No. State of County of 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. tl Legal description of property being improved: S,,\tk&. V.-6,v\Al `101,4_ 3(u (47t09 —ZS 09 —25 —21 E:,3 r- SelvfA kVA fp, USIA- Io—B L-01`1- Address of property being improved: ht Sheol 'Of.. MV-:(\\: %C_.\ rZCr c1eN` FL 322-2)3 1 `` (-C-4\02—‘0-6P3 General description of improvements: EP Cil \i-)61\ " ) �Vi _ \ i \C�\l C (JAc . K-4\uz .. 0 \t j K10,1 4 Owner . ..X.CCnA(1 101A (hf\ - j v WV.-- 1autik Address ig L D &\,,D t- \�. '[ kc kA\-� ?Grin F. L 3 2233 Owner's interest in site of the im rovement St c...A1i (QEF-I(..) ,k\ ;.L. c.( . N'r:\t�c.J Fee Simple Titleholder(if other than owner) I Name Address _ II Contractor AA(-r�} \ Q 1nC l�G t c - r V i C tS,- v\C, (i\ilt(-�14I tI 16i t is Ili Address I lull 4AY'y\Wt0tL J i S Oti 01N-1c-A- 5 t-./v7As H0.1 FL— 3z_ et/ Phone No. l9(M k-12 . .f703 Fax No. Surety(if any) Address Amount of bond$ Phone 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 Phone 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 Statutes.(Fill in at Owner's option). \ ,_`_- ' '4► inr Name ate . . �1.'^. .-7.: ► .. Utz IIE Address V IVI OS Wre+A,t ic, \ V c i\- A Q-.Ntn\ti..shr.e., ):----L_ 3208` Phone No.�04-427_—S G3 Fax No. Uu Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date Is specified): +t.'' ^ This SPACE FOR RECORDER'S USE ONLY / 0 NER 247— Before �E Signed: /.iii ` i DATE /� e°A "�. Before me Is . - day of 4r QST d' In the o County of Duva, tate of F orld as._ .onal appeared n K S A(a h L .o \to-L A\CJ\ herein by Doc#2017218205,OR BK 18127 Page 100, himself/herself and affirms that all statemdnt and declarations herein • v p `m Number Pages:1 are true and accurate m z o ff ( - Recorded 09/25/2017 at 11:26 AM, o r„ Ronnie Fussell CLERK CIRCUIT COURT DUVAL ` Q z a COUNTY f♦ 7 m as RECORDING$10.00 `� No Public a an ill•tate of F V , County of f1.l V 'l c 4 0 -i My mmission exp:--. E. o E z Personally KnownO m Produced Identification at CEJ if`i Fi C Ln44— or , Ni