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1830 SEMINOLE RD - PREMIT DWAY18-0014 Ab%p CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 DRIVEWAY - SINGLE OR TWO FAMILY DRIVEWAY MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: DWAY1 8-0014 Description: paver driveway Estimated Value: 5000 Issue Date: 5/22/2018 Expiration Date: 11/18/2018 PROPERTY ADDRESS: Address: 1830 SEMINOLE RD RE Number: 1720200510 PROPERTY OWNER: Name: MILLER STEPHANIE Address: 1830 SEMINOLE RD ATLANTIC BEACH, FL 32233 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: Praft Guys, Inc. Address: 6967 Phillips HV\fY JACKSONVILLE, FL 32216 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. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. * 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. Permit Con4itions Ci,typf Atia,ntic, Beach, J Permit Number: DWAY18-0014 Description: paver driveway Applied:5/10/2018 Approved:5/17/2018 Site Address: 1830 SEMINOLE RD Issued: 5/22/2018 Finaled: City,State Zip Code:Atlantic Beach,FI 32233 Status: ISSUED Applicant:<NONE> Parent Permit: Owner: MILLER STEPHANIE Parent Project: Contractor:<NONE> Details: LIST OF CONDITIONS SEQN0 ADDED DATE REQUIRED DATEI -SATISFY DATE, TYPE STATUS DEPARTMENT CONTACT REMARKS 1 5/14/2018 EROSION CONTROL INSTALLATION INFORMATIONAL PUBLIC WORKS Scott Williams Notes:: Full,erlosion control measures must be installed and-approved pnorto beginning any,earth..Idisturbing activities. Contact the Inspection Line(247- �814)�o request an Erosion and Sediment Control Inspection prior to start of construction. 2 5/14/2018 ON SITE RUNOFF INFORMATIONAL PUBLIC WORKS Scott Williams Notes:' All runoff must remain'on-site during construction. 3 5/14/2018 ROLL OFF CONTAINER INFORMATIONAL PUBLIC WORKS Scott Williams Notes: Roll off container company must be on I City approved list.(Advanced Disposal,Realco Recycling,Shapell's,Inc.,Republic Services,Donovan Dumpsters). Container.cannot be.placed on City right-of-way., 4 5/14/2018 RIGHT OF WAY RESTORATION INFORMATIONAL PUBLIC WORKS + Scott Williams Notes; Full right-of-way restoration,including sod,is required.. 5 5/14/2018 RUNOFF INFORMATIONAL PUBLIC WORKS Scott Williams Notes,� All runoff must remain on-site. Cannot raise.lot elevation. Printed:Tuesday,22 May,2018 1 of 2 0_00_2� 10 Permit Conditi-ons City of Atlantic Beach ADDITIONAL COMMENTS P INFORMATIONAL 6 5/14/2018 WORKS PUBLIC WORKS Scott Williams Notes'; This property will be M-axed out in'rega.rd to impervious area. This Permit must'stay t rue to plan area or less. p Printed:Tuesday,22 May,2018 2 of 2 City of Atlantic.Beach APPLICATION N.UMBER 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@coab.us Date'routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM 13-D Property Address: I Department review required Yes No Bold inq,____ P.111111 �' innnn��ag i,g�-- Applicant: �ww 6W 4,yy(-. Tree Administrator Project: C�_Public YEO 2r !� Public Utilities Public Safety Fire Services i6w fee $ Dept Simature' .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: WApproved. FIDenied. [:]Not applicable (Circle one.) Comments: BUILDING QE4 .�Q_N�INQ�- W-(��_ING Reviewed by: Date: TREE ADMIN. Second Review: FlApproved as revised. ODenied. []Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: E]Approved as revised. F]Denied. E]Not applicable Comments: Reviewed by: Date: Revised 05/1912017 Building Permit Application City of Atlantic Beach 800 Seminole Road,Atlantic Beach, FL 32233 Phone: (904) 247-5826 Fax: (904) 247-5845 JobAddress: 1830 SEMINOLE RD ATLANTIC BEACH,FL32233 Permit Number: vi —0 Legal Description 36-20 09-2S-29E SELVA MARINA UNIT 9 LOT 5 BLK 1 RElt 172020-0510 Valuation of Work(Replacement Cost)$__�e 000 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 Residential If an existing structure,is a fire sprinkler system installed I EIVEPTree Removal Submit a Tree Removal Permit Application if any trees ar= t Describe in detail the type of work to be performed: Pavers M Ay 0 20is Florida Product Approval# for multiple products use product approval form PropertV Owner Information But I)ePartment Name: Eric and Stephanie Miller A Ar, Nni L city Atlantic Beach State FL z! 3=P�one 84�-425-8391 E-Mail ericmiller03199gmail.com Owner or Agent(if Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company: Pratt Guys, Inc. Qualifying Agent: Address6967 Philips Hwy. cityJacksonville State FL Zip32216 Office Phone 904-737-4652 Job Site/Contact Number 904-982-6301 State Certification/Registration#CBC 056685 E-Mall.JustingPraftGuys.com Architect Name&Phone# Engineer's Name&Phone# Workers Compensation 001-WC17A-75108 Exempt/Insurer/Lease Employees/Expiration Date Application is hereby made to obtain a permit to do the work and installations as indicated. I certifV 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. (Sign ure of Owner or Agent including Contractor) (Signature of Contractor) Sign te rn to(or affirmed)before me this day of Signed and sworn to(or affirmed) before me this day of wo M I llk., '7 he--Ae by j4y A%^Ch ,0 S by Aeup (Signature of Notary) NATHAN NIEDEL �N..=�,, N A HAN N EDE "I T I L te of F lor da. yp Sta om mi,sic i n 0 �State of Flori da_N 0 ta ry Pu b lic Comm ss i= 10 n # GG 1 2 6453 y Co m m is s NATHAN NIEDEL 6S State of Florida-Notary Public P(,, Commission # GG 126453 %�,,%�State of.Florida-Notery Public *= commiss My Commission Expires M C -P xp I r(?_ J rn n E q .4_ y 0 m I ssio uly 2 0. July 2 0. 2 0�I ion # GG 126453 _Vop fro \ Personally Known OR July 20, 2021 6/personally Known OR My Commission Expire s 6leproduced Identification July 20, 2021 1 Identification [ ]Produced Type of Identification: L Type of Identification: Brian Broedell From: Justin Belichis <justin@prattguys.com> Sent: Thursday, May 17, 2018 9:02 AM To: Brian Broedell Subject: Re: 1830 Seminole Road Driveway Permit Hey Brian, I just spoke with our designer, and he confirmed that no part of that square-shaped paver deck is elevated 3 0 above the the grade. Also, our client ended up removing the pergola from their scope of work. It's just a paver deck on this one. We also sent a separate permit application for their driveway. Please let me know if you have any other questions and I'll be happy to answer them. Best, Justin On Wed, May 16, 2018 at 3:51 PM, Brian Broedell <hhroedell@coab.us> wrote: Hey Justin, Regarding your paver driveway/hardscape permit for 1830 Seminole Road, is the 12'-10" by 16'-10" square shown in the backyard just a paver pad/deck or is it a pergola/structure? If it is just a pad/deck, is any part of it elevated 30" or greater above the grade? I see that a cedar pergola was removed from the permit, so I am unsure if something is still being proposed in the backyard. Please advise. Thanks, Brian Broedell Planner TREE VEGETATION AFFIDAVIT City of Atlantic Beach Department of Community Development Planning&Zoning Division 800 Seminole Road Atlantic Beach,FL 32233 (P)904 247-5800 (F)904 247-5845 PERMIT# SECTION I-APPLICANT INFORMATION 0 w n e r(s) Legal Authorized Agent* NAME OF APPLICANT Eric and Stephanie Miller NAME OF COMPANY Pratt Guys,Inc. ADDRESS OF COMPANY 6967 Philips Hwy.Jacksonville,FL 32216 PHONE 9047374652 CELL EMAIL Justin@PrattGuys.com CONTRACTOR CERTIFICATION NUMBER CBC056685 ATLBCH BUSINESS TAX RECEIPT NUMBER MC772.309 SECTION 11-SITE INFORMATION STREET ADDRESS OF PROPERTY 1830 Seminole Rd.Atlantic Beach,FL 32233 If an address has not been assigned to this property,contact the AB Building Department at(904)247-5826 to request an address. 1 LEGAL DESCRIPTION 36-20 09-2S-29E SELVA MARINA UNIT 9 LOT 5 BLK 1 LOT 5 BLOCK SUBDIVISION Selva Marina i REAL ESTATE NUMBER 172020-0510 LOT OR PARCEL SIZE: 9052 SQ FT AC RESIDENTIAL X COMMERCIAL OTHER(SPECIFY) yp" ,2 ME I affirm that have reviewed the provisions of Chapter 23, "Protection of Trees and Native Vegetation"of the Municipal Code or Ordinances for the City of Atlantic Beach,FL andlor/have participated in a pre-application meeting with the Administrator of those regulations. Subsequently,/affirm that no regulated trees and no regulated vegetation will be damaged,destroyed andlor removed from the above-.described or adjacent properties in conjunction with this project. 'r-7 Sl((��OWNER SIGNATURE OF OWNER Signed and sworn before me on this 17-day of by State of County of Identification verified: �y NATHAN NIEDEL of Florida-Notary Public Commission # GG 126453 s Oath sworn: F Y e s F My Commission Expir]Jes No 2021 July 20t� Notary Signature My Commission expir REV-TVA-00.72 es: 71 zol-7 City of Atlantic,Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) ow Atl ��-001 800 Seminole Road MAY 1 2018 lantic Beach, Florida 32233-5445 At Phone(904)247-5826 - Fax(904)24.7--5845 ate routed: E-mail: building-dept@coab.us L'L? City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 'Sun't(i - Department review required Yes - No Buildin iq— Applicant: CA 0a LL� S '4-a C 1:TP_1anninq_&Zonin§--, Tree Administrator Project: kljw aki gug'mim&r�' P61bric Utilifie's" Public Safety Fire Services ReView fee $ __t�Si nature Review or Receipt Other Agency Review or Permit Required of Permit Verified By Date 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: APPL)CATION STATUS— Reviewing Department First Re.view: 5KApp.roved. [:]Denied. [:]Not.applicable (Circle one.) Comments: BUILDING. PLANNING &ZONING Reviewed Date: TREE ADMIN. Second Review: [-]Approved as revised. ElDenied. F]Not applicableg' Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: F]Approved as revised. []Denied. ONot applicable Comments: Reviewed by: Date: Revised 05119/2017 REVOCABLE ENCROACHMENT AGREEMENT REVOCABLE ENCROACHMENT AGREEMENT 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 ep,) (— t- �TE-POA 4 P-I LAICE 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. This work is generally described as 119AWEP OklutwillY 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 )q3O 5~6L-f AD. 01-41Tt bMCA1&I ?213? • 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 easement or 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 easements, 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 thi s permit and that all of said liabilities are hereby assumed by the USER. Date t Prop r/Agent(signed in presence of Notary Public) STATE OF FLORIDA, COUNTY OF DUVAL The foregoing instrument was acknowledged this Z, day of AJjl-,cA 20 by who personally appeared before me and (prilted name of Signer) acknowledged that he/she signed the instrument voluntarily for the purpose expressed in NATHAN NIEDEL State of Fiorlda-Notary Public Commission #GG 126453 .�2z� '74�,Jd v:,4 v My Commission Expires -.jgjy 2p,2021 Signature of Notary Public, State of Florida Department Approval: Personally Known Produced Identification(Type) W *K�rJctor Scott iffialms,Public Kayle Moore, Public Utilities Director H:\Master Forms\Public-Utilities Works Forms\Revocable Encroachment Agreement 2.5.18.docx Revision Date:2/5/18 A` CITY OF ATLANTIC BEACH CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS 800 Seminole Road 904-247-5800 Atlantic Beach,Florida 32233-5445 Fax 904-247-5845 PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION. Date 5 80�2,0 k? PERMIT# 193 0 Sem wo t,c k o, A pA/v nc ec,p 10 522., ISSUED BY THE CITY Job Address _,,FL Permitee: Oeec a Telephone# NZ 5- 93� Permittee Address: 7 Requesting Permission to Construct: COVER D9 I v E V//�y Location: (Reference to Cross-Street) S-uk oF 1P i-k S�md I NoA W SArv&o/l 614', 1. Applicant declares that prior to filing this application he has ascertained the location of all existing utilities, both aerial and underground and the accurate locations are shown on the sketches. A Letter of Notification was mailed to the following Utilities/Municipalities: Jacksonville Electric Authority Yes No Date: Bell South Telephone C�gnpany Yes Noo Date: Ferrell Gas'JOV C1 Yes No 06) Date: Comcast Yes No Date: 2. 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 of 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. 3. All work shall meet City of Atlantic B h r Florida Department of Transportation Standards and be performed under the supervisioX, of P(Tr GUKS,IAL. C(3C 0 S&&Y'S_(Contractor's Project Superintendent) located at VIGI 1(hi(gs Hw,,, -5Ac-KS--vvLl[,6 FL Telephone* c1oq-737-4(4S2 4. All materials and equipment shall be subject to inspection by the Director of P'ublic Works or his designee. 5. 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. S. 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- imp girvious area on:owner's lot or ini the,citv R:ic_i ftt�of'Aay. are to,be fricludedwitft tfffs application'. 7. This permittee shall commence actual construction in good faith with 60 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. 8. 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. 9. The Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again immediately upon completion. OWNER ==NATHANNIEDEL ate of lor a Notary Publl A4VsState of Florida *E Commission GG 126453 qj:�:) Signed Date. My Com m E x pi r 05, ss, on Befon e this 11 Z-e day of n the Co ntX pf Duval, My Commission Expires "%W July 0 0 1 'M%% 20, 2021 State Of Florida,has bersonally appeared f-M "I /I Notary Public at Large,State of Florida,County(If Duval. Mycommisspne Ires: 7/Zd,/-W Personally Known: f2�z� �NQU I Produced Identification:/ Building Permit Application City of Atlantic Beach 800 Seminole Road,Atlantic Beach, FL 32233 Phone: (904) 247-5826 Fax: (904) 247-5845 Y _0 0 1 JobAddress: 1830 SEMINOLE RD ATLANTIC BEACH,FL32233 Permit Number: Al,I , Legal Description 36-20 09-2S-29E SELVA MARINA UNIT 9 LOT 5 BLK 1 R Elt 172020-0510 t)$ 5 000 Valuation of Work(Replacement Cos _r Heated/Cooled SF Non-Heated/Cooled Class of Work(Circle one): New Addition Alteration Repair Move Derho Pool Window/Door Use of existing/proposed structure(s)(Circle one): Commercial Residential If an existing structure,is a fire sprinkler system installed Submit a Tree Removal Permit Application if any trees ar=tElf4faEOTree Removal Describe in detail the type of work to be performed: - Pavers M Ay 10 20 Florida Product Approval# for multiple products use product approval form PropertV Owner Information Bu .1CLoepartment A F,4A1641..FfiEF Name: Eric and Stephanie Miller L 0'"---pl�one 843-425-8391 city Atlantic Beach State FL Zi 3 E-Mail ericmiller03199gmail.com Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company: Pratt Guys, Inc. Qualifying Agent: Address6967 Philips Hwy. CityJacksonville State FL ZiP32216 Office Phone 904-737-4652 Job Site/Cont'act Number 904-982-6301 State Certification/Registration#CBC 056685 E-Mail Justin g PraftGuVs.com Architect Name&Phone# Engineer's Name& Phone# Workers Compensation 001-WC17A-75108 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. (Sign ure of Owner or Agent including Contractor) (Signature of Contractor) Sign' worn to(or affirmed) before me!this I-L day of 'Signed and sworn to(or affirmed)before me this_L2- day of A17Wagy- , 2-0 1 by e mJ41t,- Ae%rc.6 7,C21 S, b drA e y &rml - QL)_ (Signature of Notary) NATHAN NIEDEL NIEDEL -40 ��,,!:,State of Florida-Notary Public NATHAN P Commission # GG 126453 State of Florida-Notary Public My commission Expires Commission # GG 126453 July 20, 2021 Personally Known Vpersonally Kn MY Cornmission Expires ORE own OR Vproduced Identific Produced Identification July 0. 2021 Type of Identification: PL Type of Identification: - - i W. NOTICE OF COMMENCEMENT Stateof. Tax Folio No. S / 67 Countyof E)UVAL To Whom It May Concern: The undersi-ned hereby informs you that improvements will be made to certain real property, and in accordance with Secti on 713 of ZP the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT. Legal Description of property being improved: S G-2-0 09-1) <� -Z9f 5 ELVA M M!WA VAI I LOT S Address of property being improved: 193o SEmyj6&C- A-MAA11-1c- �rAo ; ICZ -3?-233 General description of imprqvements: Owner: rkl(- + �fc-P*W-Jr MIL,161Z Address: 5 3o 56M I AJb tLr ft �TZAN_16 6eAr_111VUZ 522 .73 Owner's interest in site of the improvement: FEE SIM100F Fee Simple Titleholder(if other than owner): Name: Contractor: e�AIT GUYY, JAIL "COS6 (- S5 A dress: -7 P141 t 1 )9 6'1/(5 OW111 C.F�_ 3 2,Z TelephoneNo.: 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: _5_1JSTN Ubo4K Address: C, fultlP� -5AcK56wv1t(_1 ,FL 3221 (, TelephoneNo: 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 OW Signed: Date, da Before e=this ' �7 vof /Ma/lirb in the _o nty of buval,State ppt Of Floriii as personally appeared e? 44 Notary Public at Large,State of Florida,C nty of Duval. Ny commission expires: Doc#201811181!,ORBK18383 Page48O. -rsonally Known: or �oduced Identification: Number Pages:1 Recorded 05/10/2018 02:12 PM, NATHAN NIEDEL RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL '�--,'S'State of Florida-Notary Public COUNTY Commission #GG 126453 RECORDING $10.00 P_,zF� My Commission Expires July 20, 2021