2329 Seminole Road RES20-0014 Int Remodel, Window Door, AC Unit 3 RESIDENTIAL PERMIT PERMIT NUMBER
risf RES20-0014
�, CITY OF ATLANTIC BEACHISSUED: 1/28/2020
800 SEMINOLE ROAD.1J;319' ATLANTIC BEACH. FL 32233 EXPIRES: 7/26/2020
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:
INTERIOR REMODEL,
2329 SEMINOLE RD RESIDENTIAL ALTERATION WINDOWS AND DOORS / $25000.00
RESIDENTIAL RELOCATE A/C UNIT
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
168908 1204 BLUFFS
COMPANY: ADDRESS: CITY: STATE: ZIP:
PRINCIPLE CONSTRUCTION 1619 N DUNNS BRANCH DR JACKSONVILLE FL 32218
OWNER: ADDRESS: CITY: STATE: ZIP:
KNABB FRANKIE C TRUST 3707 ORTEGA BV JACKSONVILLE FL 32210-4347
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.
FEES
wilt -
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $180.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $90.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $8.40
STATE DCA SURCHARGE 455-0000-208-0600 0 $5.60
WORK WITHOUT PERMIT 455-0000-322-1000 0 $290.00
Issued Date: 1/28/2020 1 of 2
fr.•Iv'f% RESIDENTIAL PERMIT PERMIT NUMBER
j RES20-0014
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ISSUED: 1/28/2020
u;tivr ATLANTIC BEACH. FL 32233 EXPIRES: 7/26/2020
TOTAL: $574.00
Issued Date: 1/28/2020 2 of 2
CERTIFICATE OF ACCEPTANCE OF
APPOINTMENT AND AUTHORITY
OF
SUCCESSOR CO-TRUSTEE
WHEREAS, on February 10, 1999, FRANKIE C. KNABB created the
FRANKIE C. KNABB LIVING TRUST, (the "Trust") pursuant to that certain
Declaration of Living Trust dated February 10, 1999, by and between
Frankie C. Knabb, as Grantor, and the same Frankie C. Knabb, as
Trustee; and
WHEREAS, FRANKIE C. KNABB, as Grantor and Trustee, amended and
restated the Trust on October 29, 2015 and further amended the Trust
on March 6, 2019; and
WHEREAS, during her lifetime FRANKIE C. KNABB was Trustee of the
Trust until she died on November 2, 2019; and
WHEREAS, Article XI, Paragraph B of the Trust, as amended,
appointed as STACEY K. MONAGLE and NATALEE K. LEGGETT as Successor Co-
Trustees of the Trust; and
WHEREAS, NATALEE K. LEGGETT desires to confirm her acceptance of
appointment as such Successor Co-Trustee, and confirm her service as
Successor Co-Trustee from and after November 2, 2019, the date of
Frankie C. Knabb' s death;
NOW, THEREFORE, the Successor Co-Trustee states and confirms the
following:
1 . Attached hereto is a true copy of ARTICLE XI of the Trust, as
amended, appointing me as Successor Co-Trustee of the Trust.
2. Attached hereto is a true copy of ARTICLE XII of the Trust,
as amended and restated, setting forth the powers that I may exercise
in behalf of the Trust without court order.
3. I have and do hereby accept such appointment as Successor Co-
Trustee of the Trust from and after November 2, 2019, and I have been
serving in such capacity from that date.
/IN WITNESS WHEREOF, I have hereunto set my hand on this VI day
of J C,rv.....a , 209
Signed, sealed and delivered in
the presence of:
Cr
Print Name: us6.1n j• Watz
1'0 if:ZhC ti. --effj?... r(
NATALEE K. LEGGETT
,j, _
Print Name: L <1 `t i t'r
STATE OF FLORIDA
COUNTY OF DUVAL
This instrument was acknowledged before me this IL{ day of
, 201194 by NATALEE K. LEGGETT, who (is) (is not)
persona y known to me or who produced as identification
and who ditake an oath.
G -) t_11- ....,t-
NO-tar
,^11- ....
Notary Public, County and
State Aforesaid
.. LU S.STUART
� Naery Public•State of Florida
'1,W, e` Commission I GG 215750
' w rs.. My Comm.Expires Aug II,2021
Bonded through National Notary Assn.
•
"B• A ointment of Sur Trustees. Upon Settlor' s
death, or incapacity as determined by a court of competent
Jurisdiction, or upon the rendering of the written medical
opinion by the physician primarily treating Settlor that Settlor
is unable to take care of Settlor' s affairs, Settlor hereby
appoints her daughters, STACEY K. MONAGLE and NATALEE K. LEGGETT,
as Successor Trustees of the Trust, to serve without bond. If
either Successor Trustee is unable or unwilling at any time for
any reason to serve or to continue serving hereunder, the
remaining Successor Trustee shall serve alone. Whenever the term
"Trustee" is used in the Trust documents, it shall mean the
original Trustee or the Successor Trustees or Successor Trustee,
as the case may be.
is)
___ ie)
•
FRANKIE C. MAWS —3- 40
ARTICLE XII. POWERS OF TRUSTEE
The Trustee or her successors, in addition to the powers
conferred by law, in their discretion and without any leave or
-}/t12,44,2/*Me,
FRANKIE C. KNABB`
order of Court or other judicial proceedings and without bond,
shall have the following powers and authority:
A. Retain Trust Estate. To retain, without liability for
loss or depreciation resulting from such retention, the original
assets and all other property hereafter transferred, devised or
bequeathed to the Trustee for such time as the Trustee shall
deem advisable, although such property may not be of the
character prescribed by law or by the terms of this instrument
for the investment of Trust assets and although it represents a
large percentage of all of the Trust Estate; said original
property may accordingly be held as a permanent investment .
B. Hold Uninvested Cash and Unproductive Property. For
any periods deemed advisable, to hold cash, uninvested, even
though the total amount so held is disproportionate under trust
investment law or would not be permitted without this provision,
and to retain or acquire and hold unproductive realty or
personalty.
C. Invest and Acquire. To invest and reinvest Trust
assets in any type of property or security, without regard to
the proportion that investments of the type selected may bear to
the entire Trust Estate, without limitation to the classes of
Trust investments authorized by law, and without regard to the
possibility that the investments may be in new issues or in new
or foreign enterprises. The property acquired may be realty or
personalty and may include life insurance, bonds, debentures,
leaseholds, options, easements, mortgages, notes, mutual funds,
investment trusts, common trust funds, voting trust
certificates, and any class of stock or rights to subscribe for
FR.ANKIE C. KNAB= 16
stock, regardless of whether the yield rate is high or low or
whether or not the new asset produces any income at all. It is
intended that the Trustee shall have the authority to act in any
manner deemed in the best interest of the Trust involved,
regarding it as a whole, even though certain investments
considered alone might not otherwise be proper.
D. Exercise Options and Conversion Privileges. To
exercise any options, rights, and conversion privileges
pertaining to any securities held by the Trustee as Trust
assets.
E. Sell and Lease. To sell, convey, grant options to
purchase, lease, transfer, exchange or otherwise dispose of any
Trust asset on any terms deemed advisable, to execute and
deliver deeds, leases, bills of sale, and other instruments of
whatever character, and to take or cause to be taken all action
deemed necessary or proper in connection therewith.
F. Insure. To carry any insurance deemed advisable, with
any insurer, against any hazards, including public liability,
and to use insurance proceeds to repair or replace the asset
insured.
G. Lend. On any terms deemed advisable, to lend Trust
funds to any borrower, including the Personal Representatives of
Settlor' s estate and the Trustee or beneficiary of any Trust, by
whomsoever created, and to change the terms of these loans.
This authorization includes the power to extend them beyond
maturity with or without renewal and without regard to the
existence or value of any security therefor, to facilitate
payment thereof, to change the interest rate thereof, and to
1
FRANKIE C. KNABB 17
consent to the modification of any Guarantee relating thereto.
H. Borrow. To borrow whatever money the Trustee deems
desirable for any Trust on any terms from any lender, including
the Trustee and the Personal Representatives of Settlor' s
estate, and the Trustee, or beneficiary of any other Trust, by
whomsoever created, and to mortgage, pledge or otherwise
encumber as security any assets of the borrowing trust.
I . Tezm of Duration of Obligation. Incident to the
exercise of any power, to initiate or change the terms of
collection or of payment of any debt, security, or other
obligation of or due to the Trust Estate, upon any terms and for
any period, including a period beyond the duration or the
termination of any or all Trusts.
J. Compromise or Abandonment of Claims. Upon whatever
terms the Trustee deems advisable, to compromise, adjust,
arbitrate, sue on, defend, or otherwise deal with any claims,
including tax claims, against or in favor of any Trust; to
abandon any asset the Trustee deems of no value or of
insufficient value to warrant keeping or protecting; to refrain
from paying taxes, assessments, or rents, and from repairing or
maintaining any assets; and to permit any asset to be lost by
tax sale or other proceeding.
K. Distribution in Cash or in Kind. To distribute any
shares in cash or in kind, or partly in each, and the Trustee' s
valuations of assets upon making distribution shall, if made in
good faith, be final and binding on all beneficiaries; to make
the election to recognize gain or loss pursuant to Section
643 (e) of the Internal Revenue Code with respect to all in kind
F'RANKIE C. KNABB 18
distributions to the beneficiaries in any one (1) calendar year.
L. Use of Nominee. To hold any or all of the Trust
assets, real or personal, in the Trustee' s own name, or in the
name of any corporation, partnership or other person as the
Trustee' s nominee for holding the assets, with or without
disclosing the fiduciary relationship.
M. Bid in or Take Over Without Foreclosure. To foreclose
any mortgage, to bid in the mortgaged property at the
foreclosure sale or acquire it from the mortgagor without
foreclosure, and to retain it or dispose of it upon any terms
deemed advisable.
N. Pay Off Encumbrances. To pay off any encumbrance on
any Trust asset and to invest additional amounts to preserve it
or to increase its productivity.
0. Vote Stock. To vote stock for any purpose in person or
by proxy, to enter into a voting trust, and to participate in
corporate activities related to any Trust hereunder, in any
capacity permitted by law, including to serve as an officer or
director.
P. Participate in Reorganizations. To unite with other
owners of property similar to any held in Trust in carrying out
any plan for the consolidation, merger, dissolution,
liquidation, foreclosure, lease, sale, incorporation,
reincorporation, reorganization, or readjustment of the capital
or financial structure of any association or corporation in
which any Trust has a financial interest; to serve as a member
of any protective committee; to deposit Trust securities in
accordance with any plan agreed upon; to pay any assessments,
C7'641:1 . d
FRANKIE C. KNABifzil,i, 19
expenses, or other sums deemed expedient for the protection or
furtherance of the interests of the beneficiaries hereunder; and
to receive and retain as Trust investments any new securities
issued pursuant to the plan, even though these securities would
not constitute authorized Trust investments without this
provision.
Q. Purchase Property From Estate. To purchase property,
real or personal, from Settlor' s or a beneficiary' s estate upon
such terms and conditions as to price and terms of payment as
the Trustee and the respective Personal Representatives shall
agree upon, to hold the property so purchased in Trust, although
it may not qualify as an authorized Trust investment except for
this provision, and to dispose of such property as and when the
Trustee shall deem advisable.
R. Employment of Assistants and Agents. To any extent
reasonably necessary, to employ attorneys at law, accountants,
tax specialists, brokers, investment counselors, realtors,
managers for businesses, farms, ranches, groves and forests,
technical consultants, attorneys-in-fact, agents and any other
consultants and assistants the Trustee deems advisable for the
proper administration of the Trust Estate.
S. Manage Realty. To deal with realty in any manner
lawful to an owner thereof. This authority includes the right
to manage, protect, and improve it, to raze, alter and repair
improvements, to sell or contract to sell it in whole or in
part, to partition it, to grant options to purchase it, to
donate it, to convey it, to acquire it, release, or grant
easements or other rights relating to it, to dedicate parks and
FRANKIE C. KNABB 20
thoroughfares, to subdivide it, to vacate any subdivision or any
part thereof, and resubdivide it from time to time, to lease it
in whole or in part, and to renew, extend, contract for, and
grant options in connection with leases. Leases, contracts to
sell, mortgages and any contract entered into by the Trustee can
be made on any terms and for any period, including a period
beyond the duration or termination of any or all Trusts .
T. Carrying Several Trusts as One Estate. To the extent
that division of the Trust Estate is directed hereby, to
administer the Trust Estate physically undivided until actual
division thereof becomes necessary to make distributions; to
hold, manage, invest and account for whole or fractional Trust
shares as a single estate, making the division thereof by
appropriate entries in the books of account only, and to
allocate to each whole or fractional Trust share its
proportionate part of all receipts and expenses; provided,
however, this carrying of several Trusts as a single estate
shall not defer the vesting in possession of any whole or
fractional share of a Trust for the beneficiaries thereof at the
times specified herein.
U. Carry On Business. With respect to any business that
may be or become a part of the Trust Estate, whether organized
as a sole proprietorship, partnership or corporation, upon such
terms, for such time, and in such manner as the Trustee deems
advisable:
1. To hold, retain and continue to operate such
business solely at the risk of the Trust Estate and without
liability on the Trustee' s part for any losses resulting
FRANKIE C. KNABB 21
therefrom.
2 . To incorporate, dissolve, liquidate, or sell such
business at such time and upon such terms as the Trustee deems
advisable.
3 . To borrow money for business purposes and to
mortgage, pledge or otherwise encumber the assets of the Trust
Estate to secure the loan.
4 . To exercise with respect to the retention,
continuation and disposition of such business all the rights and
powers of which Settlor would have been capable, including all
powers as may now or hereafter be conferred upon the Trustee by
law or as may be necessary to enable the Trustee to administer
the Trust Estate in accordance with the provisions of this Trust
Agreement, subject to any limitations thereof that may be
provided for herein.
V. Allocation to Principal and Income. All receipts of
money or property paid or delivered to the Trustee and all
expenses shall be allocated to principal or income in accordance
with the laws of the State of Florida.
W. Statutory Powers . In addition to the powers enumerated
hereinabove, Settlor gives to the Trustee all powers enumerated
in Florida Statutes Sections 736. 0815 and 736. 0816 by
incorporating said powers herein by this reference.
X. Disclaimer. To make, execute, record and deliver a
disclaimer or disclaimers, including partial disclaimers, which
are so-called "qualified disclaimers" under applicable state
laws and the applicable provisions of the Internal Revenue Code.
Y. Termination of Trust . To terminate any Trust herein
(77 ,;(-
FRANK I E
'7 .FRANKIE C . KNABB 22
created when, in the sole judgment of the Trustee, the corpus of
the Trust is or becomes too small in amount to warrant the
existence of the Trust, taking into consideration the intended
purpose behind the formation of said Trust . In the event a
Trust is to be terminated in accordance with the preceding
sentence, the remaining principal and undistributed income of
such Trust shall be distributed to the then income beneficiary
or beneficiaries in accordance with their actuarially determined
interest in such Trust.
FRANXIE C.
City of Atlantic Beach APPLICATION NUMBER
r Building Department (To be assigned by the Building Department.)
800 Seminole Road R /,
s� Atlantic Beach, Florida 32233-5445
E7_() v O ( 4
Phone(904)247-5826 • Fax(904)247-5845
� ,,rilos%' E-mail: building-dept@coab.us Date routed: 1 /1 (A, ''O
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Z 3 LCJCJnt,uOc:: ;n D= - . - .4 ent review required Ye/ No
C) Building,
Applicant: PR (.._, A,.„),,_ ( , .g &Zorn. , ..
Tree Administraof
Project: l �—�j(CD{Z 1 (�{v0 • Public Works
o ; / Public Utilities
` c o s �-- t 2---- Public Safety
� \ � Fire Services
R)e koc .--�7( � A 0 ()(-\c
Review fee $ Dept Signature
D f
Other Agency Review or Permit Required Review or Receipt Date ti
of Permit Verified By
_�°O ��
Florida Dept.of Environmental Protection .,Q,
Florida Dept.of Transportation n1/4))
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: KProved. ❑Denied. ❑Not applicable
(Circle one.) Comments: —ni r S pt.r M i T 5 0 f 5'''...yl'rcz 4.d vixi. A
BUILDIN S Wdetk 0RcJe r• Preit re double -Rtua. /TT
Coe'-oc-hnt /1-Reds #o S v3ri bow CDnr`PS o it -I-A-t 104 c M.
PLANNING &ZONING 0 4-k4 p`y— Reviewed by: v ' Date: /-i7rd-0
TREE ADMIN. Second Review:
IAp oved as revised. I (Denied. ['Not applicable
PUBLIC WORKS Comments: �/1 Are rfxci-lion S)14.441f p v-t-z4 . .+-p Rec-eiV,l5
Per.14-
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
.!-Ji-%- Building Permit Application OFFICE COPY Updated l0/9/18
_.. ') City of Atlantic Beach Building Department **ALL INFORMATION
\ 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
�-E•r - IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: a 3a i S.z.,r,;..p i.e R,) Permit Number: R 2_0 s OC) (4
Legal Description ,.I ....• Yu $- .. IAC RE# /(, q 0$ ().O
Valuation of Work(Replacement Cost)$ aC,ii- Heated/Cooled SF Non-Heated/Cooled U
Z N
• Class of Work: ❑New Addition 411Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door QJ Z
_JOaO i
• Use of existing/proposed structure(s): ❑Commercial ®Residential 11 Zi Z
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ®No nw 0 c !ia
OmQo a
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit)<.X7tVp 40O
Describe in detail the type of work to be performed: /'C - 1)'n•.w4 R le..ip .1 , Irl•`iv►; Z a Az
6:,,,,,+/4 c. a /olr.. Z - ( to r.t-:c►-. o-F A:r j6 '. -. . 4v u j (,v t+'4 3 s ® ,cg O Q
as ,o) al^ss s1;ai.,a P„ o,., o�Qi r - 0
Florida Product Approval# for multiple products use product appera$toO Z
W
Property pwner Information I�” �/ j U_ O Er 2
Name Na.,-- i e� 62 Et. Address x321 (5e.1711 111 Ci. K. CI ,.. a cr m
','I,, : H w p W
City �,tx t �. State FtZip Phone �U ��p -.�(U ,
E-Mail ViVJ fG 'eft (& O— • ov--7-1 LU 0 N UJ W
Owner or Agen (1`Agent, Power of Attorney or Agency Letter Required) 5 CC La 5
W
Contractor Information EL CC
Name of Company par.,n.c.;pa( # t2A i,c Qualifying Agent eivgn1.p s Qqr%) Mu.11 bs
Address/A/4 .. •.,w., 13*. Dh Iv , City '7E4.* State F . Zip 3 >].cLg
Office Phone q lit 53c/ (o f a -i Job Site Contact Number 9 O 3341 64 67
State Certification/Registration# C KC 0574 0 1 E-Mail (CNa ti /1 ;5 53 a l m.; I. lab^.
Architect Name& Phone# ,0h K q G G/C) 96 9 70}' /) sv
Engineer's Name&Phone# .54--,4,-.4.
Workers Compensation Insurer OR Exempt* Expirati�,,"Date' Y •, :' '`, ' ` '
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify t(1atio work or installation bas •
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 theAlpirinn2ogahis
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. I
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be cionejitcPAidattitideelich, FL
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
T IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
0
Tp 0: AIN FINANCING, CONSULT WITH YOUR LEN, :R OR AN ATTORN 4 :EFORE
• a,- ' PING YOU• OTICE OF COMMENCEMENT. /01_,,L. f //
.) 'if'' I '' a ' I 1 SA '' -1
} = o .n Z (Signature of• der or Agent) (Signature of Contractor)grind and sworn to(or affirmed)before me this day of d and sworn to r •ffirm Q bb�efore me this1 5 ay of
cj z `V• '1.'._ y NI. ' 4 '/0.20 JD A' , 20/'�by C" �`r 1"C tit N"liu), ))/
�
U8 (Signature o Not. ) 1 (Signature of • OTA/2y -.,''
> Z h My Comm.Expires 9N,^
o� ]Pe .onally Known OR [ ]Personally Known OR June 28,2022
```"Oct _ Comm.#GG 233661 F.
ot-Pr••uced Identific ionProduced Identification -
Y
e • Identification. � Type of Identification: % A Q'��
qi.rr� •
opi 11 lll\\\\\
Doc # 2020011957, OR BK 19071 Page 1005, Number Pages: 1,
Recorded 01/15/2020 12 :42 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10 . 00
n
fer,rri /cESc - CSGlq OFFICE COPY
NOTICE OF COMMENCEMENT
•
State of F-talui U q Tax Folio No. /4 g f'6 7 — I 1-4:Y'
County of. bit V q_.'
To Whom It May Concern:
The undersigned hereby informs you that Improvements will be madelto certain real property, and in accordance with Section 713
of the Florida Statutes,the following Information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: u L.4,.1 t5 a Pkit f is 37 —
Address of property being improved: .23 14 a� PUPA.;C. eck i-•
General description of improvements: .11•INolJAL9-u .A_4 i,'L.ti-% 0101 j 1- f e.81r
Owner: Al tq 1 ae. L e fye h- Address: a 3ay S 71...4-to L Re)r At6sG
Owner's interest in site of the Improvement: Otu►u.,
Fee Simple Titleholder(if other than owner):
Name: /�
Contractor: ?it;AL;p 60we11�/`&c¢?)/`s Ze_ • —
Address:f 419 .balm.,. � c Zit.. 1')'''��[ ���1�zG ACL 3) 1'8 //t�--__ .
Telephone No.:10(1 3 BI tai 7 fes4.N €r+.1 CE'MN)I�S S� tY^��
Surety(if any) iU.14
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the Improvements
Name:
N.A.
Address: I •
—
Phone No: Fax No:
Name of person within the State of Florida,other than himself,designated by owner upon whom noticeslor other documents may
be served:Name: N•11,
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: CI'W444S lvl.y 11; 55
Address:f(0 Il , N ' "St-t. F1 3 1.248
Telephone No:9 09 3 3¢ 4967 . 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): —
i
THIS SPACE FOR RECORDER'S USE ONLY OWNER
2
Signed: �y /` ' Date: I/3)20 24
Cynthia Young Before m �'�
et Is 1�, day of rat;/. alma.. In the o my of Duval,State
• *Ar Notary Public Of Florida,has personally appeared fir/ 'GSL '
' * State of Florida Notary Public at t_apge,Staf�plor ddCountyof Duval.
My commission expires: "J
4oFF,ocs My Commission Expires 10/05/2020 Personally Know n: or
Commission No,36480 ,Produced Identif cation:{Gt. I,U
ur lCt COPY
Llri
� r PRODUCT APPROVAL INFORMATION SHEET FOR THE CITY OF ATLANTIC BEACH, FLORIDA (*REQUIRED)
*Project Address: a 'k /13 - Permit#: res Sc)
*Owner/Project Name: tOcc_,,l
As required by Florida Statute 553.842 and Florida Administrative Code Rule 9B-72, please provide the information and product approval number(s)for
the building components listed below as applicable to the building construction project for the permit number listed above. You should contact your
product supplier if you do not know the product approval number for any of the applicable listed products. Information regarding statewide product
approval may be obtained at:www.floridabuilding.org.
Category/Subcategory Manufacturer Product Description Limitation of Use State# Local#
A. EXTERIOR DOORS
1.Swinging
2.Sliding <.'. re7 (.• `Jh r s\� �1 c. 1;4 V-i53ti a.
3.Sectional
4.Garage Roll-Up
5.Automatic
6. Other
B.WINDOWS
1.Single hung C
2. Horizontal slider
COLS D �: .`�.. f -� _ I t sS. 3
3. Casement
4. Double hung
5. Fixed
6.Awning
7. Pass-through
8. Projected
9. Mullion
10.Wind breaker
11. Dual action
12. Other
Page 1 of 4 Updated 10/17/18
OFFICE COPY
In addition to completing the above list of manufacturers, product description and State approval number for the products used on this project, the
Contractor shall maintain on the job site and available to the Inspector, a legible copy of each manufacturer's printed specifications and installation
instructions along with this Product Approval Sheet.
I certify that this product approval list is true and correct to the best of my knowledge. I further certify that use of different components other than the
ones listed in this document must be approved by the Building Official.
*Contractor Name(Print Name): 4.74'r I i S *Contractor Signature:
*Company Name: -P.'11,N.c2116 ( ,Lre t\P•
*Mailing Address: RIM &A-O 'C, ‘...b_ ,.tee ty,, t.L
*City: asz jLSa,. JJ 1.' *State: F ) . *Zip Code: -1-1:1-
*Telephone Number: /1 �{ *E-mail Address: c 1-14 £ J J iS 3�d��(tic�� ( .
4CMZ
Cell Phone Number: &f - 3'3� �� �•7 Fax Number: h!
Page 4 of 4 Updated 10/17/18
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3.� 1 Cash Register Receipt Receipt Number
� City of Atlantic Beach R12007
DESCRIPTION I ACCOUNT I QTY I PAID
PermitTRAK $55.00
RES20-0014 Address: 2329 SEMINOLE RD APN: 168908 1204 $55.00
BUILDING WINDOW DOOR INSTALL 03/11/2020 RBE $55.00
BUILDING WINDOW DOOR INSTALL
455-0000-322-1002 0 $55.00
03/11/2020 RBE
TOTAL FEES PAID BY RECEIPT: R12007 $55.00
Date Paid: Tuesday, March 17, 2020
Paid By: PRINCIPLE CONSTRUCTION
Cashier: FJ
Pay Method: CREDIT CARD 9
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Printed:Tuesday, March 17, 2020 4:22 PM 1 of 1 4