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1835 HICKORY LN - DEMO DEMO PERMIT PERMIT NUMBER f: ' CITY OF ATLANTIC BEACH DEM019-0003 ISSUED: 1/24/2019 800 SEMINOLE ROAD ATLANTIC BEACH. FL 32233 EXPIRES: 7/23/2019 MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION. ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES . ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY. 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. JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK: 1835 HICKORY LN DEMO PARTIAL INTERIOR & EXTERIOR DEMO $0.00 TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION: CONSTRUCTION: NUMBER: GROUP: SELVA MARINA UNIT 172020 1438 12C R/P COMPANY: ADDRESS: CITY: STATE: ZIP: FERGUSON BUILDERS INC. 317 3RD STREET ATLANTIC BEACH FL 32233 OWNER: ADDRESS: CITY: STATE: ZIP: STORY GRAHAM N 1835 HICKORY LN ATLANTIC BEACH FL 32233-4547 WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR 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. LIST OF CONDITIONS Roll off container company must be on City approved list. Container cannot be placed on City right-of-way. DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT DEMOLITION 455-0000-322-1000 0 $100.00 PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 TOTAL:$129.00 Issued Date: 1/24/2019 1 of 2 „ ., Building Permit Application Updated 10/9/18 . ,..,, City of Atlantic Beach Building Department **ALL INFORMATION 'iv:-� �y 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY '.u%+t9' IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: `2' S /--(Z --i*Ce,R-y 1-,4, PermitNumber: D E1v\D19 -O©03 Legal Descriptt c7--2169Q ^-2 s--'-pl 2-) S��4 Vq. Y9.6) A0t) 4- 67,7 / ? /„A -( Valuation of Work(Replacement Cost)$ /2 Heated/Cooled SF Non- ed g� D � CT fa • Class of Work: ❑New DAddition DAlteration DRepair ❑Move DemPoo Window/Do • Use of existing/proposed structure(s): ❑Commercial sidential • If an existing structure,is a fire sprinkler system installed?: ❑Yes.-No • Will tree(s)be removed in association with proposed project?❑Yes(must submit separate Tree Removal Permit) ❑No Describe in detail the type of work to be performed: ��br=-,r Vi--c-1<- ^367 f) `E''-{}li/f/AAr �� 'g- 64 Li a i 'CC210 K- C E K 'Feet o fL Florida Product Approval# A fA for multiple products use product approval form Property Owner Information / Name ::-' 1erPyU` �TZ)RJ Address ten c- 01 c\ CQ ' !A - City ' TLAt—Tl t' .i\c\� State Zip S2 Z�� Phone 'C� 7:4iJ SI_ 3( E-Mail_ SV i_P- C.,Y.v.-i) GGAt-c pcSt. NiL\-- Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company >�j”{ U•5O1J SeUl4-42ig-R.13 /4Q. Qualifying Agent - g-15rJ Address -76. C&4d OkAi8, City 4Yt., 7, State ''t- Zip RQ-2$6 Office Phone (<1C-)k' Cl ` 3 .1 /s..' Job Site Contact Number q V`/cc/ State Certification/Registration# E-Mail 0-kl- R �j LZ Q. 641L .a--ep X41 Architect Name&Phone# Ag A Engineer's Name&Phone# Workers Compensation Insurer OR Exempt❑ 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 regulating 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 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. 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 I' YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTA\ F AN G, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDI ' 0,U'�. • COMMENCEMENT. , .moi = -- (9,1) (Signature of Owner or Agent) (Sign. ure Of Contractor) III "ed :nd sw,rn to(or affirm-mm: .efore me this day of Si ed and sworn to(• af'r •-• befeert d. of . _ y IIII ,,`e<'' 7 . ,1 `bY��° "p'\ fir. yi%�'E�o!� 4 'z. e of i. (Signatu - NO I1 1' - +�. TONI GINDLESPERGER :'d TONT GINDLES''9� `'� ' MY COMMISSION#FF 924951 :At ,: Personally Known OR ,: [ ]Personally Known OR =,: , ,,: MY COMMISSION#FF 924951 � � _.: sr ►r [ Produced Identification ' EXPIRES:October 6,2019 ]Produced Identification 114 8� Bonded pubhcUES:October nd2e019e�T .e of Identification: ';/ , 9ondedTAruNot rycltelicUnderwrite. Type of Identification: Notary .... --- NOTICE OF COMMENCEMENT State of ( ( Tax Folio No. County of (..„V CL,( 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 informa 'on is stated i this NOTICE OF COMMENCEMENT. Legal Description of property being improver: 3 `z� y'�2 3" .2 Op 1 i- ('Z-e-- KiLiaL g.7- .9' Lip Y- la' Address of property being improved: (9 ..- 0\-CYcill �L 1\ P`'\IC-- 1�4 1 Z :?22,. ...) , Gen.eral..desrription oLimpco_vemn ats• tri.)caner: (-51 `-f\ S Address: ( 14: > j Owner's interest in site of the improvement. 6'I-f, \ i Fee Simple Titleholder(if other than owner): ------ Name: Name: Contractor: ik...C•cU.5. $i 0/ D A .. 45 C, 6-4)42A— R-6-0,5-,='6...J Address: 4c7 �i...dp, / Y`� . , / jx 2 12-3-33-3 Telephone l‘:cj 0 1 )c 6�3' 13 66— v Fax No: �//- Surety(if any) _- �' Address: /`i Amount of Bond$ Telephone No: 7 Fax No/ Name and address of any person making a loan for the construction of the improvements Name: Address: Z VZ • 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: Address: Telephone No: 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 thp,5439444caling unless different date is specified): .4"i, #, 6Wll tti! MY COMMISSION#FF924951 '``^ '7= EXPIRES:October 6,2019 THIS SPACE FOR RECORDER'S USE ONLY OWNER N �`� t `' 8ondedm, Notary Public ii•erwr-rs Doc#2019019663,OR BK 18669 Page 2290, Signed • \ Date: fir/ Number Pages: 1 Before m: i day o' in the Count o Du •I,State Recorded 01/24/2019 03:18 PM, Of Flor':a,ha• personally appear: 11 a 4. -;� .4.. ' RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Nota Publi at Large,State if ida,County• M CJ COUNTY �� RECORDING $10.00 My commission expires: Personally Known: _ — , �� l� or Produced Identification: • 6 0- • r, - S 9 '"(