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457 SARGO RD FNCE19-0031 FENCE& RAIL PERM Ali fFENCE WALL OR BARRIER PERMIT PERMIT NUMBER `N FNCE19-0031 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ISSUED: ATLANTIC BEACH. FL 32233 EXPIRES: MUST CALL INSPECTION PHONE LINE (904) 2 14 BYI4 PM FOR NEXT DAY INSPECTION. ALL • ' CONFORM • THE CURRENTtT EDITION (2017) OF THE FLORIDAOUILDING CODE, AND OF ATLANTIC + CH CODE OF i ' + ALL CONDITIONS OF PERMIT APPLY, PLEASE + + . 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 pei mits required from other governmental entities such as water managem._�nt districts,state agencies, or federal aj;encies. JOB ADDRESS: PI DESCRIPTION: VALOOF WORK: 457 SARGO RD FENCE WALL Of; BARRIER FENCE FENCE AND RAIL $6648.00 TYPE • BUILDING SUBt • • ROUP - ROYAL PALMS UNIT 171499 0000 02A3.00 • • ` � � eRAJIV SUPERIOR FENCE AND RAIL 5470 HIGHWAY AVE JACKSONVILLE FL 32217 OF NFL • �. FREEMAN JUANITA 457 SARGO RD ATLANTIC BEACH FL 32%33-3815 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. Roll off container company must be on City approved list. Container cannot be placed on City right-of-way. 1 PUBLIC WORKS ON SI-1 E RUNOFF INFORMA ZONAL Notes: All runoff must remain on-site during construction. 2 PUBLIC WORKS ROI L OF-CONTAINER INFORMATIONAL Notes: Roll off container company must be on City approved list(Advanced Disposal,Realco Recycling,Shapells,Inc.,Republic Services,Donovan Dumpsters, Phillips Containers,JDog/Dennis Junk Removal,All American Roll Off,WCA Waste Corporation). Container cannot be placed on City right-of-way. Issued Date: 1 of 2 FENCE WALL OR BARRIER PERMIT PERMIT NUMBER FNCE19-0031 CITY OF ATLANTIC BEACH ~~ 800 SEMINOLE ROAD ISSUED: ATLANTIC BEACH. FL 32233 EXPIRES: 3 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL Notes: Full right-of-way restoration,including sod,is required. 4 PUBLIC WORKS FENCING REMOVED INFORMATIONAL Notes: All old fencing must be removed from job site by Contractor. DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT BUILDING PLAN CHECK 455 0000-322 1001 0 $17.50 FENCE 455-0000-3221000 0 $35.00 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: $81.50 Issued Date: 2 of 2 tL:Ly; City of Atlantic Beach APPLICATION NUMBER Building DepartmentA _.. (To be assigned by the Building Department.) r 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 E-mail: building-dept@coab.us HAR 1 1 201'1 'Date routed: City web-site: http://www.coab.us APPLICATION REVIEW ANIS TRACKING FORM Property Address: `T 5-7 De ent review required Yes No Applicant: �J Panning &Zoni ree ministrator Project: , is Works P ublic 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 b�Y;� � atEk: TREE ADMIN. Second Review: Approved as revised. []Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed b >6 Date: �� FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 CITY OF ATLANTIC BEACH Department of Public Works ' 1200 Sandpiper Lane Atlantic Beach, FL 32233 A'.� (904) 247-5834 PUBLIC WORKS PLAN REVIEW COMMENTS Date: 3/12/19 Property Owner: Juanita Freeman Permit#: FNCE19-0031 Email: Not Provided Review Status: DENIED Contractor: Superior Fence and Rail Site Address: 457 Sargo Road Email: david.f@fencingiacksonville.com 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: • A Revocable Encroachment Agreement must be submitted. APPROVED The form is on our website under Building Department- "Permit Applications and Forms" and also at the Building Department located at City Hall. 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, Shapells, Inc., Republic Services, Donovan Dumpsters, Phillips Containers, JDog/Dennis Junk Removal, All American Roll Off, WCA Waste Corporation). 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/904-247-5834 Resubmittal Notes: All revisions and changes shall clearly stand out from the rest of the drawing on the sheet as a revision by way 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\PLAN REVIEW COMMENTS\FNCE19-0031(Owner-Freeman).docx Revision Request/Correction to Comments **ALL INFORMATION HIGHLIGHTED IN City of Atlantic Beach Building Department GRAY IS REQUIRED. 800 Seminole Rd, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: I—r-�C. —C)C)3 ❑ Revision to Issued Permit OR ❑ Corrections to C r mments Date: 2,L 7 O J Project Address: `-t� Q� Contractor/Contact Name: yQn c re 2m G1 n Contact Phone: -Z4 6 —27yy Email: Description of Proposed Revision/Corrections: Ee V C-) C- c- r C)CL-C-- km !�Y& I _\ i)4I(fir � 1'e em cx/--\ affirm the revision/correction to comments is inclusive of the proposed changes. (printed name) • Will proposed revision/corrections add additional square foot e o original submittal? ❑No ❑ Yes(additional s.f.to be added: ) • Will proposed revision/corrections add additional increase In building value to original submittal? ❑No ❑*Yes (additional increase in building value:$ ) (Contractor must sign if increase in valuation) *Signature of Contractor/Agent: (Office Use Only) Ve/Approved ❑ Denied ❑ Not Applicable to Department Permit Fee Due$ Revision/Plan Review Comments Department Review Required: Building MAR 2 7 201 Planning&Zoning eviewed By Tree_Administrator (S . Public Works u i (ties X="y TONIOINDLESPERGER Public Safety " MY COMMISSION*FF 924951 ate Fire Services ': ,P EXPIRES:October 6,2019 Updated 10/17/18 ;;e ?Fo,.• g,,nded Thru Notary Public Underwriters REVOCABLE ENCROACHMENT AGREEMENT **ALL INFORMATION �n1 City of Atlantic Beach HIGHLIGHTED IN GRAY r ' 800 Seminole Road,Atlantic Beach, FL 32233 IS REQUIRED. REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and exis Ing under the laws of the State of Florida, hereinafter referred to as "CITY" and DcLr\tog. Ere P 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 re!\ C (2-- 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 • 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 this permit and that all of said liabilities qre hereby assumed by the USER. Date Property Owner/Agent(signed in presence of Notary Public) STATE OF FLORIDA, COUNTY OF DUVAL The foregoing instrument was acknowledged this day of �r�� 20 , by !t TCS EM C who personally appeared before me and ±ackled nt am of Signer) ed t e/she signed Instrument voluntarily for the purpose expressed in it. TONIGiNDLESPERGER Department Approval: Signature of Notary Pu Ic, tate of Florida MY COMMISSION#FF 924951 EXPIRES:October6,� ;g [ ] Personally Known _ .�,�rn �.a [ J 10 Produced Identification(Type) w,. — � Scott Williams, Pu Ior Mi r e c to r H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road _ Atlantic Beach, Florida 32233-5445 I I\')C _ Phone(904)247-5826 • Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: City web-site: hftp://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: Z[ �� �P, De ent review required Yes No Applicant: 0 Panning &Zoni ree ministrator Project: PI�,N CEis Works P ublic 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 b y z2:= Date: J �— c( TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: []Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) ,j 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 �;sljr E-mail: building-dept@coab.usDate routed: City web-site: hftp://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 4 De ent review required Yes o Applicant: Planning &Zonin Fee ministrator Project: =,N C_E is Works P ublic 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: proved. ❑Denied. ❑Not applicable (Circle one.) Comments: GDING) PLANNING &ZONING Reviewed by: Date: 1aai TREE ADMIN. Second Review: ❑Approved as revised. ❑Denie . ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 City of Atlantic Beach APPLICATION NUMBER } � Building Department (To be assigned by the Building Department.) i 800 Seminole Road 1, I\)C C, ( Q ,nO� Atlantic Beach, Florida 32233-5445 J —1 lJ s Phone(904)247-5826 • Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: City web-site: hftp://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 14S'7 � ��C1�� Deent review required Yes No Applicant: v &Zoni -Tre-e—Administrator Project: p7 -,NCEis works P ublic 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 bDate: oe TREE ADMIN. Second Review: ❑Approved as reviled. []Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 S!-;\,'J-z'� R'.401U ng Permit Application Updotedl0/9/18 City of Atlantic Beach Building Department "ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED. Job Address:4-ClG�r Permit Number:_��,�, 1 QC]3 Legal Description c A6 11:y'—C) 1Z RE# Valuation of Work(Replacement Cost)$__(o(pr 49' Heated/Cooled SF Non-Heated/Cooled • ClassofWork: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial ❑Residential • If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No • Will trees be removed in association with proposed roiect? ❑Yes must submit separate Tree Removal Permit 110 Describe in detail the type of work to be performed: r Florida Product Approval# _ for multiple products use product approval form Property Owner Information Name Address .S a{v City r C State 1-[&Zip Phone E-Mail A C) Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information r Name of Company .JtJ 1012_ c0Quali ying Agent Address- 70 1 U)01K a r4L 111 1p__ City C f1 State Zip_ Office Phone d F3' Job Site Contact Number iOly) :3$-�Z - State Certification/Registration# E-Mail_ �Q� %1 —!�►s� �" Architect Name&Phone# Engineer's Name&Phone# Q— Workers Compensation Insurer OR Exempt o 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 IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. I -YC)U INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNE EFORE RECORDING tY URN TICE OF COMMENCEMENT. (Signatur of Owner or Agent) (Signature of Contractor) ed nd s rn to(or a . ed)before me his day of Signed and sworn to(or affirmed)before me this day of © Y lV nn Q by ( nature N to (/ (Signature of Notary) [ ]Personally Known ORPaersonally Known OR [ ]Produced Identification w °ti ;: MYCOh.11A1.;1c: Irld I entification Type of Identification: EXPIRES OciuTyP% nti cation: 'Fp 4. Bonded Thor Notary Pubfc Unden.4te.'s Owner Builder Affidavit **ALL INFORMATION HIGHLIGHTED IN r City of Atlantic Beach Building Department GRAY IS REQUIRED. 800 Seminole Rd, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 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 $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY" OR THE FLORIDA"CONTRACTORS CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904- 247-5826 OR BUILDING-DEPT@COAB.US ) IF IN DOUBT. V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. Job Address: Jl bJ 7 50. �c �� a° =A 1/,9_ 1 r Owner Name: h fQ//r1J ]hA.. _�Q m( ,, /J Phone Number: q©�J a./rC� � Mailing Address: Q-1-/, le d-A City: G, ll,-Daa' State: �Q. zip: 1 Notarized Signature of Owner - Th oregoing ins rument was acknowledged before me this day of in the State of Florida, County of Signature of Notary Public [ ] Personally Known OR [ ] Produced Identification Type of Identification: c,--- r,—„- - - ------ ated 10/24/18 '.eG'••, TONI GIMLESPERGER a` MY COMMISSION#FF 924951 -': •'_ a EXPIRES:October 6,2019 Bonded Thou Notary Public Underwriters ` NOTICE OF COMMENCEMENT State of .0(,�.r Tax Folio No. 1 -7 1 49 9— Goo 0 County of Lj 1fQ To Whom It May Concern: The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT. Legal TP scription of property being improved: I-1 C 17- Z 5— Z9 E _ 4� o-C P ( o:� a P,k, n,4 Z-A L,,� 4- Address of property being improved:_A/—'S7 ,7 So—r-,<&> Geral description of improve- / ments: e!^ 7 caner: Address: Owner's interest in site of the improvement: Fee Simple Titleholder(if other than owner): / Name: a tll td 1 S' /'► tYl 0, 01,M Contractor: Address: Telephone No.: ( Fax No: T Surety(if any) Address: Amount of Bond$ 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: 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 the date"of-Yveo t date is specified): TONIGiNDLESPER3E; _ 4951r EXPIRES:October THIS SPACE FOR RECORDER'S USE ONLY OWNE ,,dedThruNotaryPumiU Signe Before me this day f in the County o Duvall,State 2nd Of Florida,has personally ppear 9052053,OR BK 18711 Page 973, Notary Public i Large,Sta e o Flo ida,County Du lumber Pages: 1 My commission expires: ecorded 03/07/2019 11:17 AM, �--- or :ONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Personally Known: OUNTY Produced Identification: — JS :ECORDING $10.00 i 11 MAP SHOWING SURVEY I= L Q - REPLAT OF PART OF ROYAL PALMS UNIT TWO A 31 1b,16A,16� l"tp � RECORDED IN PLAT BOOK PAGE PC RECORDS OF DUVAL CO.. FLA. FOR Ebopler Builders y �to z.4 , In - ° w - rr� t4 i //' o � Zn S Z3 , 5 ., ►S� Q c Ik j 'G pz u I HEREBY CERTIFY THAT 1 HAVE SURVEYED THE LANDS AS SHOWN IN—THE ABOVE CAM, AND THERE ARE- NQ ENCROACHMENTS. — s SIGNED w ' �� �9 R[OI*TKRKO mURV[YOR No.� FLOP.IDAk SCALE: Ale'"y 4f L / r / SOUTHSIDE BLUEPRINT SER@ICE, INC,1 ORDER NO