1563 Linkside Dr FNCE19-0034 Replace Fnce FENCE WALL OR BARRIER PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH FNCE19-0034
ISSUED:4/2/2019
800 SEMINOLE ROAD EXPIRES:9/29/2019
ATLANTIC BEACH. FIE 32233
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 BUILDIN(z
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 thiscounty,and there may be additional permits required from other
governmental entities such as water management districts,state agencies,orfecleral agencies.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
1563 LINKSIDE DR FENCE WALL OR BARRIER FENCE replace 6-11. privacy fence $3500.00
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP: T
1723746078 SELVA LINKSIDE UNIT02
COMPANY: ADDRESS: CITY: STATE: ZIP:
SUNSET FENCE, INC. 10418 NEW BERLIN ROAD,#106 JACKSONVILLE FL 32226
OWNER: ADDRESS: CITY: STATE: ZIP:
NICHOLSON TIMOTHY C 1563 LINKSIDE DR ATLANTIC BEACH FL 32233-7323
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.
1 1 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All mmoff must remain on-site during construction.
2 PUBLIF WORKS ROI.I OFFCONTAINER INFORMATIONA[
Notes:
Roll off container company must be on city approved list(Advanced Disposal,Realco Recyclim&Shalpells,Inc.,Republic Services,Donovan Dumpsters,
Phillips Containers,]Dog/Demus Junk Removal,All American Roll Off,WCA Waste Corporntion). Container cannot be placed on City right-cf�ay.
Issued Date:4/2/2019 1 of 2
FENCE WALL OR BARRIER PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH FNCE19-0034
800 SEMINOLE ROAD ISSUED: 4/2/2019
ATLANTIC BEACH. FIL 32233 EXPIRES: 9/29/2019
3 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration,including sod,is Peq
PUBLIC WORKS
4 FENCING REMOVED INFORMATIONAL
Notes:
All old fencing must be removed from job site b
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PLAN CIFFC� 455 0000�322 1001 0 $17 50
FENCE 455-0000 322 IWO 0 $35,00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STAIT DBPR SURCHARGE 455�20&-0700 0 $2,00
STAITUDCASURCHARGE 455�2�00 0 $200
TOTAL:$81.501
Issued Date:4/2/2019 2 of 2
City of Atlantic Beach UMBER
AP LICATION N
(To be assigned by the Building Department.)
17�7
Building Department
too Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 Fax(904)247 5845 13 2019
E-mail: builifing-dept@coatims Data muted: 21-0_Ia__�
city web-site: hftp://�.coab.us
APPLICATION REVIEW AND TRACKING FORM
;ewu
Property Address: De artment review require Yes No
uildin
Applicant: gP'anning&Zonin
Tra or
Project: Pu 1, Ublid,
uonc uldimers
u a ety
Fire Services
Review fee Dept Signature
Other Agency Review or Permit Required Review or eceipt Date
-Florida Dept of—Envmnmental Protection of Permit Verified By
Florida Dept.of Transportation
St.Johns River-Water Management District ob
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
er: — I I _J
APPLICATION STATUS
Reviewing Department Filert Review: E]Approved. Denied. E]Not applicable
(Circle one.) Comments:
BUILDING
PLANNING&ZONING
Reviewed b Date:49f*
TREE ADMIN. Second Review: r]Approved as revised. KDenied. EINot applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed b ate:-AJ97#
FIRE SERVICES Third Review: EVApproved as revised. E]Denied. EINat applicable
Comments:
Reviewed b 111"_2 Datek A.21-114
Revised 0511912D17
CITY OF ATLANTIC BEACH
Department of Public Works
1200 Sandpiper Lane
Atlantic Beach, FL 32233
(904) 247-5834
oil 9�
PUBLIC WORKS PLAN REVIEW COMMENTS
Date: 3/14/19 Applicant: Sunset Fence, Inc.
Permit#: FNCE19-0034 Email: mlob907O6l(@aol.com
Review Status: DENIED Property Owner: Lisa Nicholsen
Site Address: 1563 Linkside 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 Read.
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: APPROVED
A Revocable Encroachment Agreement must be submitted.
The form is on our website under Building Department-"Permit Applications an
and also at the Building Department located at City Hall.
PUBLIC WORKS CONDITIONS OF APPROVAL:
(rhefollowing 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 swilliarnsli/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"cloudlne. 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. Comolete new sets of drawings will not be accgpjgcL ADDITIONAL
ITEMS MAY BE REQUIRED DEPENDING UPON NEW INFORMATION AND CLARITY OF FINAL PLANS SUBMITTED FOR
REVIEW.
Page I of 1
0APublic WorkAADMIN\PLAN REVIEW COMMENTS\FNCE19-0034(Sunset Fence).dmx
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-'ALL INFORMATION
Revision Request/Correction to Comments HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Build i ng-Dept(cDcoab.us PERMIT#: FN C-C_N_OOS4
El Revision to Issued Permit OR EVcorrections to Comments Date:.
ProjectAddress:
Contractor/Contact Name: S`L)IQ -7 Z: F�; Z,
Contact Phone:9,44
Email: �VIO 2 7,�)�
Description of Proposed Revision/Corrections:
I/4-r Alf I�A�nc 4_4x,�_7
P j—/ZE Y ZV "A/5 2-7�� ZZ�V -i—
�z--�2-4— affirm the revision/correction to comments is inrhisiye�.(t�hp e. eilt'�. e
(printed name) L
• Will proposed revision/corrections add additional squarefootage to original submittal? MAR 13 2019
?No El Yes(additional s.f.to be added:
'4 I?epartment
• Will proposed revision/corrections add additional increase in buildin I t BPY1110a
i,�.�A,,gn increaseln uation
FNo -Yes(additional increase in building value:$ zz vj F'
-Signature of Contractor/Agent:
(Office Use Only)
El Approved [jrDenied Ll Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comments 4 40odh I!-
Department Review Required:
Bu"di.,ng
,::::::::j!E -— - Reviewed BV'�
Tree rm I. or
�bk Woks�
�,ctl ies h It Y:
Public Safety
Fire Services Vpd�wdI0117119
CITY OF ATLANTIC BEACH
Department of Public Works
12DO Sandpiper Lane
Atlantic Beach, FL 32233
(904)247-5834
PUBLIC WORKS PLAN REVIEW REVISION COMMENTS
Date: 3/20/19 Applicant: Sunset Fence, Inc.
Permit III: FNCE19-0034 Email: mlob9070610aol.com
Review Status: DENIED Property Owner: Lisa Nicholsen
Site Address: 1563 Unkside Drive Email: Not Provided
THIS REVISION 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 t review.
APPOM
PUBLIC WORKS CORRECTION ITEMS: CC
A Revocable Encroachment Agreement must be submitted.
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 swilliams0coab.0 /904-247-5834
Resubmittal Notes: All revisions and changes shall clearly standout 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
pendin&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 acceqtecL ADDITIONAL
ITEMS MAY BE REQUIRED DEPENDING UPON NEW INFORMATION AND CLARITY OF FINAL PLANS SUBMITTED FOR
REVIEW.
Page 1 of 1
0APublic WorkAADMIMPLAN REVIEW COMMENTS\FNCE19-0034 lRevision-Sunset Fenoe).docx
"ALL INFORMATION
0 Revision Request/Correction to Comments HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd,Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-DePtOcciab-Lis PERMIT#: f1J C 19-012
El Revision to issued Permit OR Xcorrections to Comments Date: 3-2 2-1 '5i'
Project Address:
.5-04) 5: ,f :7� eog_
Contractor/Contact Name:
ContactPhone:_ —Email: /v/_e/3 go zel,
Description of Proposed Revision Corrections:
f"13 Z_ :�EA2Cl2,�,x 05;
E UZ D
1_�V) affirm the revision/correction to comments is inclus!01� kh fJL;
(printed name)
• Will proposed revision/corrections add additional square footage to original submittal? MAR 2 2 2019
KNO El Yes(additional s.f.to be added: I
13IL"dirg Departrr.er!
?
• Will proposed revision/corrections add additional increase in building value to origin�ail'44
PrNo EI-Yes ladditional increase in building value:$ Mamr must sign if ncrsuuu�in valuallon)
*Signature of Contractor/Agent:
(Office Use Only)
42'Approved El Denied El Not Applicable to Department Permit Fee Due$_
Revision/Plan Review Comments
Department Review Required:
Building ReviewedW
Tree Administrator ! ECEIVE-
Planning&Zoning
ublic Wor MA
R 2 5 2019
Public Utilities
Public Safety Date
Fire Services Updntsd 10/17/18
REVOCABLE ENCROACHMENT AGREEMENT "ALL INFORMATION
City of Atlantic Beach
HIGHLIGHTED IN GRAY
800 Seminole Road,Atlantic Beach,FL 32233 15 REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida,a municipal corporation organized and
exist! e la rid h einafter referred to as"CITY"and
= �=�f ol 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 z���' -
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to
relocationor removal onthirty(30)days'notice by�=aid
Yluc=1 be givVy certified mail,return
receipt requested,to thefollowing 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 19-7b)
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
liabilitZiee:/ reby lu d ytrSFR.
Date
Property"nir/AgII(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this
x— dayof �.C,Ck- 20 1�1
by AbiC11DXn )6,�A WDCQ-C�t- _,who personally appeared before me and
(printed name of Signer)
acknowledged that he/she signed th instrument voluntarily for the purpose expressed in it.
JOSEITE A RE..M"
'2
sf, ' "'S: �*
F C-rdlision#FF 218MI
FF 218MI Department proval:
1 ExPlies April 7 2019
a
na ; 7 19
=pl=A
ary Public,Sta e of Florida ��T�Faa!—�,
Pe�5offally Known aa�, c—
I Prod.uced Identification(Type) Pt NvkA LI CL Scott Williams,Public Works Director
HAAxplimbons&Forms\WoM&Excal Document Originals\20180831 Ravocable Encroachment Agreementd� Ravision Date:8/91/18
--- City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road 3L
Atlantic Beach, Florida 32233-5445 �J C 0 —CID
Phone(904)247-5826 Fax(904)247-5&45 Date routed:
1"' E-mail: building-dept@wab.us
city eb-site: hftp 11�.coaous
APPLICATION REVIEW AND TRACKING FORM
_� U1l)1(!S*dJ
Property Address: De rtment review re uIre YesTNo
Kild!rn
Applicant: sk I J)�t+ rt Als iEt�
Project:
Fire Services
Review fee Dept Signature
Other Agency Review or Permit Required Review or Race P' Data
of Permit Verified By
Florida Dept.of Envirionmenial—Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Any Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beveraps and_Tob..0
Other:
APPLICATION STATUS
Reviewing Department First Review: E]Approved.. EE]Deni d. MCI applicable
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed by:
TREE ADMIN. Second Review: E]Approved as revise(d. ElDenied. E]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:—
FIRESERVICES Third Review: E]Approved as revised. E]Denled. E]Not applicable
Comments:
Reviewed by: Date:—
Ravl�OVID12017
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road 3c/
Atlantic Beach,Florida 32233-5445 CID
Phone(9134)247�5826 Fax(904)247-5845
E-mail: building-dept@mab.us Date routed:
Cityweb-site http:IN�.coalb.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: S_(0_� Ut��_Sdt -Department review reouired Y No
:2ut d 16,
Pis
Applicant: R_(X( c r ing Zoning
Tnsojkl�V —
Project: PqkL��
<—Public Utilities)
-PUBM-Fafe—ty
Fire Services
Review fee $
Other Agency Review or Permit Required Review or It Date
of Permit Verified By
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River-Water Management District
Any Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
1 Other.
APPLICATION STATUS
Reviewing Department First Review: [aApproved. ElDenied. E]Ncrt applicable
(Circle one.) Comments:
(E�)
PLANNING&ZONING Reviewed by: rh J'�� Date:N1 IJ 2 f
TREE ADMIN. Second Review: OApproved as revised. []Deniedv E]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date
FIRESERVICES Third Review: E]Approved as revised. ElDenied. E]Not applicable
Comments:
Reviewed by: Date:
Revised!0511912017
,diliffift, City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445 /1 C& tel _C0 3V
1WPhone(9134)247-5826 Fax(904)247-5845
E-mail: building-dept@ccabus Date routed: 2
Cityweb-site: http://�.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: JSJ -
Department review required Yes No
Applicant: P arming&Zoning;?
_F4 Lre5AXMn3:r
Pu ��
Project: f aka c hfi
-public Utilities
_Frlu�a ety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or pt Date
of Permit Verifie By
Flonda 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
1 Other:
APPLICATION STATUS
Reviewing Department First Review: E]Approved. armed. E]Not applicable
(Circle one.) Comments: P,
BUILDING Ferce f 5 01cr,
PLANNING&ZONING Reviewed lb"�C= Date:
TREE ADMIN. Second Review: ElApproved as revised. []Denied. E]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: E]Approved as revised. E]Denied. E]Not applicable
Comments:
Reviewed by: Date:
R.�k.d 05119/2017
AmIlit, 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-DeptiAlcoab.us PERMIT#: FNC'C_lI9-0()34
El Revision to Issued Permit OR 0/corrections to Comments Date:
ProjectAddress: 16_�,13 11,JX5A q-- b(Z-
Contractor/Contact Name: SIJA) -7217- �W_ L 'gr), 4
Contact Phone:q�q Email: 9'd 74%,11
Description of Proposed Revision/Corrections:
Vir- 21&�_"i z;-W, SAO.0�
P, 2 -i—
I li6�_ affirm the revision/correction to comments is I Gh
(printed name) RE `&VE-E)
• Will proposed revision/corrections add additional square footage to original submittal? MAR 13 2019
No 11 Yes ladditional s.f.to be added:
• Will proposed revision/corrections add additional increase in buildir I t B�ffl Department
lW1'iRV11?+' B h FL
�No -Yes(additional increase in building value:$ _ 4 C ,A a
%gag, ea�
r
z z g 'fico Ws gn ncrease nvLation)
*Signature of Contractor/jAgent:
(Office Use Only)
,P<Approved E Denied L1 Not Applicable to Department Permit Fee Due$_
Revision/Plan Review Comments
Department Review Required:
Building .11�1
�--_P_1an`mng_&_Z.nmg —) Reviewed By
Tree rm ra or
�blic W.rk�s
�—�ic fl i�Ies 3-
Public Safety Date
Fire Services Updated10117118
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RE 8CAL5: 'd,
NOTICE OF COMMENCEMENT
Stateof VL- Tax Folio No. 7
County Of 0 (A \1 A L
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 I inth!VOT[qEOFCOMMEN EVENT
C
P S 5;t 3 L,�' t�' 4�; t' ?6
Legal Descri(tiOnofpr erty being improved: 'PA
tiF c
CXI a�
Address of property being improved: /5-& L i I L)G
General description of improvements: Fe vi c-
-ri'A �) le-0 OC-5 C)
Owner: Address: t AJKZ I
Owner's interest in site of the improvement: _rYK &I Alf IM e 4-T ::a
Fee Simple Titleholder(if other than owner):
Name:
Contractor:
Address: Pj '4 1 IkJe�-i ReC (111 IZID -ffl`06 -[�y
Telephon a No.:�0(j 6 16 1,4-� Fax No: 7S-1— 2001
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 otper 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 Uenor'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 recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
�igned: Date:
Doc#2O19D567,l9,ORBKIS717 Pagel,186, seforem��d.yf �Lirj ioLP1 inthe Up Duval,State
Number Pages:I )f Florida,has personally appeared ft IJ I I IS .1
Recondecl 0&13�019 01 PNI,
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL lotary Public at Large,State ou v..
COUNTY AY Commission epiies: Or
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RECORDING $10.00 es.n.11,K IF
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