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201 PINE ST - REVISION 12-7-17 ► CITY OF ATLANTIC BEACH Al 1 800 Seminole Road Atlantic Beach,Florida 32233 417, REVISION REQUEST/CORRECTIONS TO PLAN REVIEW COMMENTS ,ems /7OZ?D Date I/ - 7-/ 7- Revision to Permit Corrections to Comments Permit# 165 ( 7C Z Project Address c2 / T" € S' /2 e e t A-1 {c /��i - �� 522 33 Contractor/Contact Name .ir / e'i 4 ' ' /, Phone �� L �y� ' 9f'0 90 Email at,/v z-411 O e,l-s77n e/ Description of Proposed Revision/Corrections: Revision Review Fee Due $ J 4�Z ii G�e� /`-4�-6Lt� e /'cam ,e c 2 re ee, sec%1 JS (41/;-‘44-4 Additional Additional Increase in Building Value $f'� r�ec c' Additional S.F. By signing below,I z affirm the Revision is inclusive of the proposed changes. i (printed name) /z - 7 ( Signa r a re o ontractor/Agent(Contractor must sign if increase in valuation) Date (Office Use Only) Approved Denied Not Applicable to Department Revision/Plan Review Comments �G ,., .lc -v • rU i C c y /T Sp-61C cit / ,r S pec/;art 1 Department Review Required: uildin /11 annifiT& Zoning iewed By Tree Administrator Public Works Public Utilities l — / Y--1 Public Safety Date Fire Services OFFICE COPY NOTICE OF COMMENCEMENT • • (PREPARE IN DUPLICATE) • Permit No. g- f 7 —O L r1'E Tax Folio No. ( 7©'56 5 6 6 6 State of ,- (Mt r","--- County of U I/ To whom It may concern: The undersigned hereby informs you that Improvements will be made to certain real property,and in accordance with Section 713 of the Florida Statutes,the following information is stated In this NOTICE OF COMMENCEMENT. // Legal description of property being improved: `5 /1p 16 Z 6 9 3 L o; Address of property being improved: 4,70/ P//tie S L eGt- 1 07Z 4-W 1_ General description of improvements: /Ve-4. eJrv,C 36 Q_44.t• - *-z,, C.tavz?A'�. IV s 171a, ri 1 L./S/l0. f j f 2tes f /ecM_tl 70 4 Owner /iy 4. Address Sr-S— Pvz__•ca •f'74• -4?-1,r4- -e(i)e.4 . /=e 30 13 h Owner's interest in site of the improvement /6 Ii e-- 3 -p✓�f _ Fee Simple Titleholder(if other than owner) Name Address Contractor V/A. rf)Afrilu v6 s ,f / 3 2/? Address 59'3 In A I SS / . ��rEt� ( 3 2-24C Phone No. f,t)'471 G 1(o 9 D 9 Fax No. Surety(if any) Address Amount of bond$ Phone No. Fax No. Name and address of any person making a loan for the construction of the improvements. Name L/Iffl /794n-11Aj .- Address /96 Be( -f Rot- S/e- f3o 2.a( Phone No. e27/-/#29 Fax No. 1L''�9.3 i 7 3� Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may be served: /` Name 7 4 tt� C.iLr1 V t2; '�� :���J?s &tP Address ! 37f--iZ i97',-f -3f /V--cte ze v, _ 44 L7 L GZ Phone No. f r4 6ZI /d/D 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). Name Address Phone No. Fax No. — — — ,....I,,.,, ' ."••''';'-s Expiration date of Notice of Commencement(the expiration date Is one(1)year from the date of recording unless a -� different date Is specified): °;0;4- P'<:E %o'. �i^m THIS SPACE FOR RECORDER'S USE ONLY OWNE: Sign" .- DATE il�aF 61-1 "u Z` Before me-s�J day-...0"':24"2"... ' �r in the n C Z' County_of Duval.State of Florida,has personally appeared o 6 ` K�Jcn 13;,. c' herein by 3 himself!Rerseif and aI1ig that all statements and declarations herein 3 �. C" are true and accurate m WI Doc#t 2017279741,OR BK 18211 Page 1130, o ^ Number Pages:1 H y a Recorded 12/07/2017 08:54 AM, :caJShWcii)^f5S r RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL 1 o COUNTY o ary Pub ib t Large,State of L Couou o`�nty of hr,uw r ry RECORDING $10.00 y mmi io expires: a23 •) ^' cn Personally Knownor NI w - < Produced Identification it pi- GraC�,-733-?q 7. -O