1875 BEACHSIDE CT - DECK 0S ? !, CITY OF ATLANTIC BEACH
3- . ) 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
'<40.21s.) INSPECTION INSPECTION PHONE LINE 247-5814
RESIDENTIAL OTHER - SINGLE OR TWO FAMILY RESIDENTIAL OTHER
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RESO18-0053
Description: Repair& Expand Deck
Estimated Value: 4000
Issue Date: 9/13/2018
Expiration Date: 3/12/2019
PROPERTY ADDRESS:
Address: 1875 BEACHSIDE CT
RE Number: 169542 0564
PROPERTY OWNER:
Name: KELLY FAMILY TRUST
Address: 2330 WATERSONG CIR
LONGMONT, CO 80504
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.
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.
(---S�vf, City of Atlantic Beach APPLICATION NUMBER
��� Building Department (To be assigned by the Building Department.)
800 Seminole Road
115..._ , ," . Atlantic Beach, Florida 32233-5445 I ESo/8'' ('�7�J
Phone(904)247-5826 • Fax(904)247-5845
'1..0;60.
L 0. E-mail: building-dept@coab.us Date routed: 8-/311/8.
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I $15 bei dts,de Cr 1 - •rtment review required Yes No
Applicant: 6 w neg...,, Fannin. &Zonin.
Tree Administrator
Project: I Itoog T ece_. R EPIiR... 4 P . • orks
1 Public Utilities
Public Safety
•
Fire Services
Review fee $ Dept Signature i
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. I INot applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed b : / /i407 / !ate: f"' / 7,1
kr," ., •/ ley.,"
TREE ADMIN.
Second Review: Approved as revised. I (Denied. ['Not applicable
PUBLIC WORKS Comments: .
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: nApproved as revised. nDenied. nNot applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
�Syvpfir, City of Atlantic Beach APPLICATION NUMBER
J ' Building Department (To be assigned by the Building Department.)
',��
� 800 Seminole Road
_.;._ fr Atlantic Beach, Florida 32233-5445 ei 0 ¢- 00,53
Phone(904)247-5826 • Fax(904)247-5845
6r E-mail: building-dept@coab.us Date routed: sI3i ler
er
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1815 fieacks i c1e Cr i - • •rtment review required Yes No
B
Applicant: (j w n eR, Planning &Zoning
^ Tree Administrator
c
Project: ) g leter,. R EPr p 1 Ig, P orks
Public Utilities
Public Safety
Fire Services
;Review fee $ Dept Signature j
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. I 'Not applicable
(Circle one.) Comments:
BUILDING (opOfPd C/P� k �s Oov e qfat e
PLANNING &ZONING Reviewed by --- Date: 23 )^ f e
TREE ADMIN. Second Review: Approved as revised. ['Denied. Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: I JApproved as revised. ❑Denied. I 'Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
S LJJ:r City of Atlantic Beach APPLICATION NUMBER
t 00 Building Department (To be assigned by the Building Department.)
.s� eESolg' 00S3
f 800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 • Fax(904)247-5845
E-mail: building-dept@coab.us • Date routed: 2/31/11!
City web-site: http://www.coab.us 111
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1815 8eacksic(e CT I - • •rtment review required Yes No
B
Applicant: /1 eR Plannin• &Zoning„)
I ,�I' � Tree Administrator
Project: le cL O 1EC. R ePH-iP • Works
Public Utilities
Public Safety
Fire Services
Review fee $ Dept Signature Ai
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. I of applicable
(Circle one.) Comments:
BUILDING 04,
PLANNING &ZONING a
Reviewed by: r � Date: --
TREE ADMIN. Second Review: A roved as revise
pp IDenied. ['Not applicable
PUBLIC WORKS Comments: .
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: Approved as revised. ❑Denied. I INot applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
0-tvpy,, City of Atlantic Beach APPLICATION NUMBER
f_.)'14-,,,,t;� Building Department (To be assigned by the Building Department.)
"` /1 .y 800 Seminole Road --�
u.,... ) Atlantic Beach, Florida 32233-5445
> ESO/3. 6053
Phone(904)247-5826 • Fax(904)247-5845
-=,/,D1110. E-mail: building-dept@coab.us Date routed: 2/3/f hr
City web-site: http://www.coab.us 1 11
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1815 8ea.ch$,de 7 rtment review required Yes o
Applicant: 0 W nek._, Planni &Zonin
Tree Administrator
Project: I cLoog necL R ii-«Z. ' • . orks
Pu• is Utilities
u•lic 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:
BUILDING
PLANNING &ZONING Reviewed by: " Date:-1-'lir
TREE ADMIN. Second Review: A roved as revised.
❑ pp I IDenie ['Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. J Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
AI " l r� Building Permit Application '
.p.. e. 12/817
., City of Atlantic Beach
OFFIC COPY
` Eri
< 800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845 &561
fJob Address: f�vv rmoE i1 ANnc t-40iJ E_( 3123-3 Permit Number: (/ 6053
Legal Description 4Z-14 'Y1-Z5 ^2ci/ oictra(f l /Z- voric, RE# uQq5' 2-151o4
Valuation of Work(Replacement Cost)$ 4(at') Heated/Cooled SF NI f Non-Heated/Cooled Iv)H'
• Class of Work(Circle one): New Addition Alteration 'epa'• Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial •-side '.I
• If an existing structure,is a fire sprinkler system installed?(Circle one): 'Yes No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit o No Tree Removal
Describe in detail the type of work to be performed:S (1t IFLIIE, COV k.2 'O L 10 ' 1q'r(N)Wei p.-Par
Dui() t0 wrnuo izic b'25 Sa fT W 'II u SVA-LAM bau ztv o EIS t-
t5or.WS ;t) Ia-c.i.Ozv ca ,33
a €f
TV (9/4-S3Sl OL - VOL- Pit Me- NO c,ilfin6F mi imps cvi1f) `Iced patters-N.- m
m „ <
Florida Product Approval# _ for multiple products use product apgovalbrrn n m
Property Owner Information 0 C m -4 rn
Name: LSL� i J ' T Address: i6)-s-- 6CA-a��i21' C( 1 m 53 m 0 C�
City ( t , _ .1i State f Zip ') Phone �U$ 19(i�3 97- ' m -n 0
-...
E-Mail i ktt3 • a.[,�cfmtli 11 e-ecw �I v C.-� '°
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) N C)
m
ontractor Information 0 0 Z 0
Name of Company: 1.1 1(.\- Qualifying Agent: iu �{ ),----11 m
Address NI City N`1r St�te_ (.� Zip 0 c n n
Office Phone_ MR Job Site/Contact Number I\.f11rZ 74 03 0
State Certification/Registration# I E-Mail 1N ii -; E
Architect Name&Phone#
`V z r
Engineer's Name&Phone# - pi •N Z r = D
Workers Compensation r v "k
Exem ,t/Insurer/Lease Employees/Expiration Date
0
Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or in ta� In
has T
commenced prior to the issuance of a permit and that all work will be per-formed to meet the standards of all the laws reg ationg
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. NOTICE:In addition to the requirements of this
permit,there may be additional restrictions applicable to t is/property that may be found in the public records of this county,and
there may be additional permits required from other go rnmental entities such as water management districts,state agencies,or
federal agencies.
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.
(S'3ature of Owner or Agent) (Signat of Contractor),
(incl contractor)
and sworn to((oor .110
ed)befor- e thiray o Signed and sworn to(or affirmed) before me this day of
1ged
7-01C� , -, G Jtt�'C , , by
1.41\11111=
(Signature of No ary) '
_ • • • ureo 'u.gy ;"F:'1.1 :''r.
* „,,.. T� i GINDLESPERStii
[ ]Personally Known OR [ ]Personally Knoi"4 yP , MY COMMISSION#FF 924951
OR • i = EXPIRES:October 6,2019
[ ]Produced Identificati r j� /� hc,1 ]Produced Identi ..:0.'s- BondedThruNotary Public Underwr�ters
Type of Identification: V L . I``-Do-ss(-Fc-3. ( ._. rpe of Identificati .
MAP SHOWING BOUNDARY SURVEY OF
LOT 12, BLOCK 1. BEACHSIDE, AS RECORDED 1N PLAT BOOK 42, PAGES 14, 14A THROUGH 14C,
OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
„ i
CERTIFIED T0: , ,(0 et, n,, 0 TM G97 r� ,,i-
,l ,� RALPH H. ANDERSON AND MAUREEN E. ANDERSON '� ,""' p �i,
BUSCHMAN, AHERN, PERSONS AND BANKSTON
t�rl' F� ��'� {��"ti �� '
TICOR TITLE INSURANCE COMPANY fbORW3 D ►ILLULJ M,0\'6fl4kI
COUNTRYWIDE HOME LOANS, INC. VAIN ro piocczisb ri-Fn..(1l k-t -;IV-
LOT 30 LOT 31 1 WIDE- 0 CtiAritiE tri pitoptfuS
BLOCK 1 BLOCK 1
S 031900" E 60.07' (PLAT) ( l/>v'11
UA("1C IVEI JI)S'
S 0312'08" E 59.68' (MEASURED)
SET 1(2' REB AR
STAMPED /W 1-136702
FWND V IRON PIP£ �-�—��j
'`/^vlJ NO IDENTIFlCATION T r C /' i0;('!.(
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LOT 13 0 LOT 11 Tin /0cL --5,e..4,_ "eve r'"`'>e_--
BLOCK 1 BLOCK 1
4.6' 5.3' ;o 0 9.5'
7.7''-r--------
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N
/�'` OFFICE COPY
Jt r'_ ,Y `� CITY OF ATLANTIC BEACH
t`' r!
OWNER / BUILDER AFFIDAVIT
- aft S?
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT
LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
• IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826)IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
OWNER-BUILDER PERMIT.
It2 } It C1I(JI?IV ( fTlvl"ljF024HONENU ER Web€ ,
ADDRESS
MI T i mc-twilt azoi
PRINT •
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)
SIGN•TURE DATE
//�'�� /[1......—__
[0
Before me this . nay ay of , ,1,01_0 in the county of
Duval,State of Florida,has personally appear herin by himself/herself and affirms that
all statements and declarations ar�true and a urate.
Notary Public at Large,State of t--- ( ,County of (
❑Personally Known
❑Produced Identscation- A
<* Y7- TONT GINDLESPERGER
Notary Signature: — ' ' = ';.'irk.:: MY COMMISSION T r 924951
I 7 rte;;a; EXPIRES:October 6,2019 '
rip '.44, `a'' Bonded Thru Notary Public Underwriters 1
F./BLDG/Owner-Builder Affadavit;REVISED:4/16/2009 'ti"cctau '1
pernl, j 44-- /2s0 / e- 0-05-,f
PY
NOTICE OF COMMENCEMENT OFFICE CO
State of 'Olaf/A- Tax Folio No. Rpq,64'2 -engf
County of 1X} f
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. this NOTICE OF COMMENCEMENT.
Description of property being improved: 42-IT 09-25 '- 291.
EUKA.aaoe Lor- 12 fUG i
Address of property being improved: [RIS 6 [ - '%.OE CX courrinc { (4}i 32.2Z3
General description of improvements: - ,/ , oil , I - e.ay III / . d i 't i 0.•,
pq to N.49 filth &I talc v pr w] `1*6 Signot 6 QA1,t, x... Lx.5`ib fili_07A I Mo IV"Uu: 0 W.
Owner: iO lA'vJ fuer Address: ie-- Cf l4'4Ot (r Kriminf fY(4( ta , 9,3'3
Owner's interest in site of the improvement: Q(,1. A-
Fee Simple Titleholder(if other than owner): i 0
Name: Mp lk
g"
Contractor: ' ' 1)44E. ns rIULF )
Address: ft1,
Telephone No.: Iv) Fax No: (J'f
Surety(if any) N I A
Address: NI Amount of Bond$ PJ)1
Telephone No: V l Pc Fax No: N lit
Name and address of any person making a loan for the construction of the improvements
Name: +N
Address: �
1�+ P
Phone No: IY 0 - Fax No: N j 0-
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other documents may be
served: Name: 1 vMh-
Telephone
I
Address: No: NI Pt Fax No: N I A-
• 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 Owner's option)
Name: N 'i
Address: N I A
Telephone No: 101,10rFax No: hi )Pr
Expiration date of Notice 9f Commencement(the expiration date is one(1)year from the date of recording unless a different date is
specified): ry P
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Signed: n Date: 8 3 d
Before me this o %• • _ ZO(em the County of Du al,State
Doc#2018205365,OR BK 18510 Page 991, ?f Florida,has personally a.,: • . tj
Number Pages:1 If otary Public at Large,State o'1.�'•rida,Co r ".uval.
Recorded 08/30/2018 12:44 PM, i _ _ /
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL dy commission expir _
COUNTY 'ersonally Known: t�� or
RECORDING $10.00 'rod- .-.:--,!+,,,...---7--171"7",; ,fig&.1, 0(i- -4i,' -w SS
•�:�:y
n.& MY COMMISSION U FF 924951
=s• a EXPIRES:October 6,2019
4 °p' Bonded TIhnr Notary Public Underwriters
/1
`"'h,,, Building Permit Application Updated 12/8/17
City of Atlantic Beach
iy � 800 Seminole Road,Atlantic Beach,FL 32233
I
1 Phon (9 )247-5826 Fax:(904)247-5845 �/� N,� / /�
Job Address: t6 2 I I611'T")C Y�v Permit Number: C6mnti 6 g.—O 6(7
f
rI
Legal Description RE#
Valuation of Work(Replacement Cost)$_ 95, °0O pleated/Cooled SF S I 0 0 Non-Heated/Cooled
• Class of Work(Circle one): New Add tion 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?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
De rriibe in detail the type of work to b performed: IAC'_ Of GI Owe.�v i 0 4.
Florida Product Approval# for multiple products use p(oduct approval l form .
Property Owner Information ,�b e, v tto y., t,--pC do-sa-c ro.d
Name: �" 1 0Ai ' iess� X CM LI— . Address: /U j 3 2., Steil Ve5 t Q/v i
City � c.C.ik56/►d•I7 !State }%L- Zip c"3),„t3 7 Phone y'oy A33 ,5",�'1s
E-Mail hOWLty/'OP\)qp' J"c LP. `Gw\
Owner or Agent(If Agent,'Power of Attorney or Agency Letter Required) 11 644.)1.Md S 41.550 jr
Contractor Information
Name of Company: eriG 1 . 1Z/t••[7 4alifyingAge t: ..✓" fri"�` C._—
Address 4C� ( � eel /s' 1- er
_City Y ate j- Zip Z
Office Phone - '30e /Contact Number CI te, ; 'lye./ ` . c_i/
State Certifica • n/Registration# 3C ( 7 C
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation
-s/Expiration Date
Application is hereby made to oh r� 'ndicated. I certify that no work or installation has
commenced prior to the issu- v meet the standards of all the laws regulationg
construction in this jurisdi ,r ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS, POOLS, FURNP E:In addition to the requirements of this
thepublic records of this county,and
permit,there may '/`�� VI./
there may be additic. \ l !gement districts,state agencies,or
federal agencies. \ *)
OWNER'S AFFIDAVIT: I cm• >'4 r ./ will be done in compliance with all
applicable laws regulating cor, \�//
WARNING TO OWNER: ► 0o 0 iCE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING 1 \ 10 YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CON_ \ u JER OR AN ATTORNEY BEFORE
RECORDING YOU ' N TICS F C. ,f.
I --/ ", 11�
(Signature of Owner or gent) -1/471j—' (Signature of Contractor)
(including contractor) •b-
Signed and sworn to(or affirmed)before me this lb day of Signed and sworn to(or affirmed)before me this 22 `?Jay of
.f1 cyjr, , c)-0 a ,by f-101-0 Vinci shauJ Russe_11,3r 1(,C�IiC , 2010 , by ' 11 COP (11E5 G
0 li_ Yrk.cu ia._.e xt. - I 04e 1 e-
(Signature of Notary) _'--:-
= =- T
11,V.4 REFIK •RALIC
Y CHARLENE MARIE BENNETT [ ]PersonallyKnown OR11:4,..J+•'''''.1.11)
. ,''• MY COMMISSION#FF 970610
�C]-Personall Known OR ,��,��.,,,, f•d ,,.� :�'
Produced Identification =� '',., '"t Commission#FF 949741 [ ]Produced Identification +,.'�'''F SPIRES:March 13,2020
Type of Identification: =• = ,Ay Fxpires March 21.2020 Type of Identification: • _• V --P—__.°-__:,_7„.
_—_ -u --'V
'.P ag's, Bonded Thru Troy Fain Insurance 8003857019