1861 Sea Oats Dr FNCE18-0054 CITY OF ATLANTIC BEACH
r 800 SEMINOLE ROAD
- ATLANTIC BEACH,FL 32233
� :; c• J INSPECTION PHONE LINE 247-5814
FENCE WALL OR BARRIER - FENCE
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: FNCE18-0054
Description: install 6-ft. wood fence
Estimated value: 3780
Issue Date: 6/25/2018
Expiration Date: 12/22/2018
PROPERTY ADDRESS:
Address: 1861 SEA OATS DR
RE Number: 172020 0540
PROPERTY OWNER:
Name: HALVERSON JOHN THOMAS
Address: 1861 SEA OATS DR
ATLANTIC BEACH, FL 32233-4511
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: ARMSTRONG FENCE CO
Address: 3226 TALLEYRAND AVE DON MILLER
JACKSONVILLE, FL 32206
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$7,500.
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach,Florida 32233-5445
Phone(904)247-5826 Fax(904)247-5845
yr E-mail: building-dept@wab.us Date routed: I
City web-site: http:GWww.coab.us
APPLICATION `R,EVIEW AND TRACKING FORM
Property Address: (��Y ( Sta DGtS N Department review required Ye No
A( � It
Applicant: !1`! MC (1hf 'I LQnning onin
Tr minlstrator
Project: 1 ^$�-Gt 1 1 �D— T Y . Wt��O� -�-/ICp
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
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: ❑AppIroved. t rDenied. ❑Not applicable
(Circle one.) Comments: Q4f1vfG 6y Qlall. 4 demon.
BUILDING '
PLANN ZONING ��/ Reviewed by: Date: Sla7Jacrer
TREE ADMIN. Second Review: WA— as revised. ❑Denied. ❑Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date: O�c70/
FIRE SERVICES Third Review: ❑Approved as revised. ❑Deri d. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 0 511 912 01]
.1lnr City of Atlantic Beach MBERBuilding Department EM]
ing Depanment.)800 Seminole RoaddW `IAtlantic Beach,Florida 322335445
Phone(904)2475826 Fax(904)247-5845E-mail: building-deptillimab.us
City web-site: hdpj/www.coab.us
APPLICATION `REVIEW AND TRACKING FORM
Property Address: t��K ' xA D�I �S O� • De artmentreviewre in uired Yes No
Applicant: /'ll (11 C'1J1�nH ��7Phublic
&Zomn
inistratorProject: Utilities
Public Safety
Fire Services
Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.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: [-]Approved. lanced. ❑/Not applicable
(Circle one.)
Comments:
BUILDING
s,t�l . -cj rpv� �eQ/`,CcS
IMIM
e
,G&ZONIII" Reviewed by:14Z Date: 523—i8
TREE ADMIN. Second Review: �Appmvecl as revised. ❑Denied. ❑Not applicable
PUBLIC WORKS Comments:��(/i • L6'
/ VeGI VGV4R'( B-0�1O
PUBLIC UTILITIES tN-\4
PUBLIC SAFETY V Reviewed 44� Date: 6-10.18
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Nolapplicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
B00 Seminole Road F'�C I -0QEq
s Atlantic Beach,Florida 32233-5445 ������yy
Phone(904)247-5826- Fax(904)247rSC45 '
,aoc E-mail: buildingdrou
ept@mab.us Date ted: S
City web-site: http://wwnv.coab.us
APPLICATION REVIEWi AND TRACKING FORM
Property Address: p l �Gt �G 1-S V wu
t review re uired Yes NoApplicant: 1f11y1��J tr/161 trn'I LQ onin— fif rrstratorProject: 1 r\s_ - j, L I �– T t . WDD -6(yss
Review fee $ Dept Signature r
Other Agency Review or Permit Required Review or Receipt Date
of Pernik Verified B
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. WJDenied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed b fA0WOR Date:
TREE ADMIN. Second Review: WA4pproved as revised. ❑Denied. ❑Not applicable
PUBLIC WORKS omments:
PUBLIC UTILITIES
r
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05179/2017
CITY OF ATLANTIC BEACH
Department of Public Works
_ 1200 Sandpiper Lane
Atlantic Beach, FL 32233
(904) 247-5834
PUBLIC WORKS PLAN REVIEW COMMENTS
Date: 5/31/18 Applicant: Armstrong Fence
Permit k: FNCE18-0054 Email: Rhall(@armstrong-fence.com
Review Status: DENIED Property Owner: John Halverson
Site Address: 1861 Sea Oats Drive Email: Not Provided
THIS PLAN REVIEW IS ONE OF MULTIPLE DEPARTMENT REVIEWS
Correction Items must be submitted to the Building Department at 800 Seminole Road.
Submittals that respond to only one or a few correction items will not be accepted.
Revisions may not be submitted until ALL departments have completed their respective reviews.
Revisions must be submitted to the Building Department and must respond to EACH department review.
PUBLIC WORKS CORRECTION ITEMS:
ROVED a i-Nc,7
• A Revocable Encroachment Agreement must be submitted.
PUBLIC WORKS CONDITIONS OF APPROVAL:
(The following comments will be printed on your permit as Conditions of Approval)
• 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., Republic Services, Donovan Dumpsters). Container cannot be placed on City
right-of-way.
• Full right-of-way restoration, including sod, is required.
• All old fencing must be removed from job site by Contractor.
Scott Williams, Public Works Director swilliams@coab.us/904247-5834
Resubmittal Notes: All revisions and changes shall clearly standout from the rest of the drawing on the sheet as a
revision byway of completely encircling the change with"clouding". The revision shall also be identified as to the
sequence of revision by indicating a triangle with the revision sequence number within it and located adjacent to the
cloud. The revision date and revision sequence number shall also be indicated in a conspicuous location in the title block
for each sheet on which a revision for that sequence occurs. For projects still in the initial review stage and permit
pending,all sheets with revisions shall be inserted into each set of drawings. The original sheets must be clearly marked
"VOID" but are to be left within the set of drawings Complete new sets of drawings will not be accepted. ADDITIONAL
ITEMS MAY BE REQUIRED DEPENDING UPON NEW INFORMATION AND CLARITY OF FINAL PLANS SUBMITTED FOR
REVIEW.
Page 1 of 1
O:\Public Works\ADMIN\PIAN REVIEW COMMENTS\FNCEI8-0054(Armstrong).docx
ECEIVEn
)UN 06 2018 CITY OF ATLANTIC BEACH
800 Seminole Road
n BY' Atlantic Beach,Florida 32233
u
REVISION REQUEST/CORRECTIONS TO PLAN REVIEW COMMENTS
F"
Date L / //P' Revision to Issued Permit_ Corrections to Comments_ Permit
Project�Addrre'sss 1X0 S vs 12,4x br
Contractor/Contact Name ATS;:1„y#_F-,= rdOy /VA/t
Phone %o'er�;' Email G 114j(e Ae A, A„
Description of Proposed Revision/Corrections: t� Permit Fee Due $ ,6l
Additional Increase in Building Value Additional S.F.
By signing below,1 (k7y�J/)/J affirm the Revision is inclusive of the proposed changes.
(prated name)
Signatureo eny(tontractor must sign if increase in valuation) Dat +
// (Office Use Only)
Approved Denied Not Applicable to Department
Revision/Plan Review Comments
c
Department Review Required:
Building
Planning &Zoning ReviwKed By
>'0-4istrator
uliWo
u is ities
Public Safety ate
Fire Services
REVOCABLE ENCROACHMENT AGREEMENT
r
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
kA I IS_ 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 W A .4a
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/,// ST W et -Lr 11yc,'yt
• 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 more 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 USER from any of the work herein under the terms of this permit and that all of said liabilities are
Jwr96y as d by the USER. Date &4
Prop ly Owne Agent(signed in presence of Notary Public) 7 �'—
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this_1 day ofJ c,w.. ,20 9,
by j q k iu 0 x l a ,ft o ,who personally appeared before me and
(printed name of Signer)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
ROBERT G.HALL
'Rigmaituic of Notary Public,State Notary Public.State of Florida
E My Comm.E%PIres Oct 24,2018 epaHmen[Approval•
? d2 Commission x FF 136580 r
Personally KnownJL e;',«,;;d:•' Banned through National Nas,Assn.
Produced ldentificadon(Type)
Scott Wi isms, ublic orks ire r/
Kayle Moore,Public Utilities Director
HAMaster Forms\nublic-Utilities Works Fonns\a omble Encroachment Agreement 2.5.18.docx
Wision Date:2/5/18
�1 city of Atlantic Beach ME
BER
Building Department �D�ecp�anment.)Soo Seminole Road MAY ) 6 �36!j �UAtlantic Beach, Florida 32233-5445
Phone(904)247-5826-Fax(904)247-5845
-�JfUjr E-mail: building-dept@coab.us
Cityweb-site: httpjt/ .coabms
APPLICATION REVIEW AND TRACKING FORM
Property Address: (f �Ct oG tS. O De artment review re uired Yes No
A I
Applicant: 11�! Ih C-�IDllh i*�r'1 LQ tannin &Zonin
— Tr mlmstrator
Project:
Public Safety
Fire Services
Review fee $ Dept Signature
or Receipt
Other Agency Review or Permit Required of PermiReview Date
tVerified B
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
I.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. of applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: T% � Date: l� le
TREE ADMIN. Second Review: []Approved as revised. [:]Denied. ❑Not applicable
PUOWORKS Comments:
BLIC UTILIT
S—/ 8-/ Date:
PUBLIC SAFETY Reviewed by:
FIRE SERVICES Third Review: []Approved as revised. ❑Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 0511912017
JOB COPY RECEIVED
Rrfiiriing Permit Application MAY i y13"IW8r2T
City of Atlantic Beach / (
BOO Seminole Road,Atlantic Beach,FL32233 C.� $ � � O,-y-y
Phono:IBO4)247-5x`626 Fax:IBM)2473645 BU!,-si... - _ -,It
Job Address: /Pbl TC a-,, Ty All4gai 6rt Permit Nurtb r....... ..... ..V,..., , -L
Legal Description
yaluation of Work(Rep!acerrent Cost)$,4200"r Nease7fc=lcd SF Non ftxted(Csrfad
e 4asscf%lorc(Clrrlsane)4New Addltlon Altcmt!on Repair Mm Demo Pool Window/Door
• Use ofeAning/proposed strvcture;s)(Clrzle-aa): Commercial Residential
• If or.e-iis!icg:✓ucn:re,is 3f!re sprirlder system icstalltdT(Qmk one): Yes No N/A
• Submit a Tree Remml Permit Appliattion If any trees an,to M rammed or 01108wt ear u�T^ Pe..rrval
Desalbem detail the type ofworkto be performed: ju.rA.l� wwd SMy}til In'o-r G' )4jrk P.T.P.
SIr.4av1•dr,W•se). -fe-- SiA tiI'i�t �a�CT.
Rodda Product App,". l#__AV� for mu!tip!e product use product approval form
Property^••-_.
Name: ffoj+N 1! lytatl Addr.s: /.V _feta- ear m-
u,v AN l ...i.'c �wwa State V[_GPSL2:i3 Phone 9pY-yaY{9W
E-Mail .V/fl
Owner or Agent(N.4gent Power of Attorney or Agency Letter Required)
Contractor Infor...>tt^n
Name of Company: Qri.,rri" -fe•[i ea. Qualifying Agent:
^ieross ^1r aC. T= SEs-...� '# O.r_ aty ff ae state 'Fi Zp 3216
Office Phonehone 9oi Y�-�li- 'aR2 Job Site/Cc _-. 11P#YR'9H-1t111 CAW
State Certification/Registration# - -_F-Mail_ "th11T
Architect Name&Phone# AIIA
Engineer's Name&Phone# 044
Workers CnmpensationA01-5410 10 of-EsY/1L
Exemp[/rrwrtr/laxFmgo/ees/FiQtiratlon M2
Application It hereby made W obtain a pemritto do the work and installations as!rdicntec.1 cortify that no work or installaticn has
ccmmerced prior to the issuance of a permit and drat aP, Rn1!!b_pa-fcrn^d tc mcctthe standards of al!the!aws regulationg
construction in thisjudsdiclion.l understand that a separate permit must be secured for ELECTRICAL WORK PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and All COND!:IOYLR;,etc NDTICC:In addtion to the requiremects of this
ptrrnt_`.e^_m3y he additlona!restrictions applicable to this prcperty `:at rsrf-e fcacd in the public records of this county,and
there may be additional permits required from ether govemi i erthits s,ch as water medag^'+^ht crstn.cn,_tato ngeneles,or
federal agencies.
O'vJHEKS AFRDAyfT:I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating constm' 'z,-.
.._ .:::iu:. .:,.. . �.. ,......a�...�...ii..�..r:.:.w��.r L,•4.�iriEWT MAY
RESULIii: _
.....,., ..,,,.., . .. �. . v....•.. ....• � ,v.n. rr.v, Jnr r. rr rVV nvsuyar
lL ....�...:: . :::.:.:...: . - .•.... r:... -�. --nivc/ BEFORe
RECORDEi::.��.��� :.� :.:.i.:i. G•:,G.:G
�� y
X� (SpatureofOwnororAgem) rcoComaaor)
(ImduEingcorrbacter) ..
Signed and swom to(or affirmed)before me this_day of Signed and swum m(or affirmed;bafora me th:s A day of
U/X ,by iatiti L1Ylr...w —14 j04R .b�Y71.T A+J.b
near KIP ° tore of Notary)
AOR,,c [�]P Ike pR ROBERTDG
(] art°m ;oMotary Public-TYPe can# rF 19L560T � pwaF[.api•� Commission BomM Thr LO Na
MAF_ OF l3U R ,/ EY
LOT 20, BLOCK 1, SELVA MARINA UNIT No. 9, AS RECORDED IN PLAT BOOK 36, PAGE
20 OF THE CURRRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
COMMIT M DEVELOPMENT I
APPRipVEp LOT 19 =
10' EASEMENT FOR PRIVATE SINGLE LOT 10
SANITARY HOUSE SEWER SERVICE LINE
N89_'S7_'1_9"E_100.06_FIELD _________________
PK.O CAPlN89'57'19"E 100.00' a o.t'
PIPE, NO CAP
6 vow YENCE PIPE.FOUN3/4'NO
IRON
O_S _ PIPE. NO CAP
B Vt L 0 NEAT
ePN _ _ O PUMP
30.0' 'dF
Q U
0
Imo-"v
N N .
l l w r
�
a O Oo 6 W Oi OLL
LL ^ 10.0'
Q
n Of LOT 20 ml w v Z z.D' W o
h m >• O BRICK WALK h Qf w W m
po o i LOT 9
v1 0.
O �i N N N w Z N o N
h O wx OP
O P 20.0' Z O
x z 0 O ro NS
Q IT Z BRICK DRIVE 5
wb r kw
�� POOL
298' WD.a'
I A/c
Tp CONCRETE i0
BRICK WALK PATIO
3'
FOUND I/2' IRON - 0.5 FW NO 1/2' IRON
PIPE. NO CAP S89'57'J,9"W 100.00' 0.4' PIPE, NO CAP
D,9
I N89'5931 W 100.13' FIELD g
LOT 21 I I €i LOT 8
wM I
LL"T
Na
N
w NOTES:
3 THIS ISA BOUNDARY SURVEY.
BEARINGS BASED ON NORTH LINE OF
o C) LOT 20 AS BEING N89'57'19"E AS
o
PER' PLAT.
P
N BUILDING RESTRICTION LINE AS PER
N PLAT.
EASEMENTS AS PER PLAT.
\90�G 0 t o z0 a0
'r SCALE: 1" = 20'
GOVND 1/2' IRON —
PIPE. NOLAP SATURIBA DRIVE
THE PROPERTY SHOWN HEREON APPEARS THIS SURVEY WAS MADE FOR THE BENEFIT OF
TO UE IN FLOOD ZONE "K' (AREA OUTSIDE JOHN THOMAS HALVERSON; OLD REPUBLIC
500 YEAR FLOOD PLAIN) AS WELL AS CAN NATIONAL TITLE INSURANCE COMPANY; AND
BE DETERMINED FROM THE "FLOOD G BRA R TITLE SERVICES.
INSURANCE RATE MAP" COMMUNITY-PANEL \I
NUMBER 120075 0001 D REVISED APRIL 17,
1989 FOR THE CITY OF ATLANTIC BEACH,
DUVAL COUNTY, FLORIDA.
D NN W. BOATWIR GHT, P.S.M.
'NOT VALID WITHOUT THE SIGNAWRE AND THE FLA. LIC. SURVEYOR AND MAPPER No. LS 3295
ORIGINAL RAISED SEAL Of A ROMDA UCENSEO
SURVEYgt AND MAPPER.' FLA. LIC. SURVEYING & MAPPING BUSINESS No. LB 3672
CHECKED BY: BOATWRIGHT LAND SURVEYORS, INC. DATE: SEPTEMBER 4, 2009
DRAWN BY: MCC 1500 ROBERTS DRIVE SHEET 1 OF 1
FILE /: 2009-0546 JACKSONVILLE BEACH, FLORIDA 241-8550 -
SIV C& ( � _ C)e:&(.(
Doc t#2018169407,OR BK 18461 Page 1470,
Number Pages:2 )g
After Recording return to: Recorded 07/1812018 02:38 PM,
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
ARMSTRONG FENCE CO COUNTY
RECORDING $18.50
3226 TALLEYRAND AVENUE
JACKSONVILLE,FLORIDA 32206
Permit No.
Tax Folio# NOTICE OF COMMENCEMENT
FS 713.13
State of Florida
County of
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property,and in accordance with
Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement.
1. Legal description of property and street address if available: /—V+ 2 v A' &e-,b �TCjro L" c.r;A,r k..,� 9
A r Q c t1—�A tiaC i u p I rt 13o a h, 3� :Z6 !Zr c#-, r
r
General description of improvement: INSTALLATION OF FENCE
n 2. Owner Information:
a. Name&Address:IIOL4 P Gly t✓s o AJ / .Si Se- v.. D "IJ Dr /9-atl�c.�i_�Y��� KL
!w� b. Interest in property: 0 aJ4
c. Name and address of fee simple titleholder (if other than Owner) N/A
3. Contractor: Name and address ARMSTRONG FENCE CO 3226 TALLEYRAND AVENUE,JACKSONVILLE,FL 32206
Phone number 904 356-2333 Fax number (optional,if service by fax is acceptable) 904 356-2332
4. Surety: Name and address N/A
Phone number N/A Fax number(optional,if service by fax is acceptable) N/A
Amount of Bond$ N/A
5. Lender: Name and address N/A
Phone number N/A Fax number (optional,if service by fax is acceptable) N/A
6. Persons within the State of Florida designated by Owner upon whom notices or other documents may be served as provided
by Section 713.13(1)(a)7.,Florida Statutes: (name and address): N/A
Phone numbers of designated persons N/A
Fax number (optional,if service by fax is acceptable) N/A
7. In addition to himself or herself,Owner designates N/A of N/A to receive a
copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes.
Phone number of person or entity designated by owner N/A Fax number(optional,if service by fax is
acceptable) N/A
8. Expiration date of Notice of Commencement(the e;Cpiration date is one(1)year from the date of recording unless a
different date is specified)
State of Florida Signature of Owner
COUNTY OF DUVAL
Sworn to (or affirmed)and subscribed before me this -2 day of �.^-. ,20_&,by 1 0��. rE�c�J �S-0 JJ
who i ,personal) know to me or who has produced
as identification and who did_or did not_take an oath.
Driver License#
Notary Public (Signature)
E.��__
n"�eROBERT G. HALLNotary Public-State of FloridaRevised 10/2002 = My Comrn.Expires OCt 24,2018
, Commission #FF 136580° i Through National Notary Assn...