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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;('!.( �� I r r�- r r . /2,o,e./?>y G i,"/r /4&_.c.,cc_ 4 t I(/ 416,0 44.1 /'I'• c 10--pC-�7'c. ice, r e.-9, r� �1 Q x ._e:. X6.4'. t i. i--IX K 22.3' c/ CI 16.5' N Q J < to - x v X..,M .' a. W u TWO STORY co o.. MASONRY & FRAME r o / 6.--1,<A-rS G^//J(( l7vo/I1 o'o n POSTED 1875 o ..,,,q.iv 0 Cv/' De,(....,..r C b/. 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-------- r ----- 7.3' m �i �0.6; }i W 4.6' • •4. . .+••.A? MO e W ?P r P• : ' Ncv OI S'l r4 00 W 6.9' 7.2' 7.0' • u i • v ... a •..1 , . . , K2 IKON E ' • .,, .. W71APfA .1,93857 • 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 • f-t -I ) 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