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1621 Sea Oats Dr FNCE20-0013 6' .„:SLA"-%_ FENCE WALL OR BARRIER PERMIT PERMIT NUMBER 7 ! I; CITY OF ATLANTIC BEACH FNCE20-0013 s-,- ISSUED: 2/18/2020 800 SEMINOLE ROAD F3 9. ATLANTIC BEACH. FL 32233 EXPIRES: 8/16/2020 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: 1621 SEA OATS DR FENCE WALL OR BARRIER FENCE 6' FENCE $4135.00 TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION: CONSTRUCTION: NUMBER: GROUP: 172020 0130 SELVA MARINA UNIT 06 COMPANY: ADDRESS: CITY: STATE: ZIP: DARMATA FENCE INC 6950 HYDE GROVE AVE JACKSONVILLE FL 32210 OWNER: ADDRESS: CITY: STATE: ZIP: MATTINGLY PAUL G II 1621 SEA OATS DR ATLANTIC BEACH FL 32233-5827 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 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL Notes: All runoff must remain on-site during construction. 2 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL Notes: Roll off container company must be on City approved list. Approved list can be obtained at the Building Department at City Hall. Roll off container cannot be placed on City right-of-way. Issued Date: 2/18/2020 1 of 2 , .,: 1-'-. .�, FENCE WALL OR BARRIER PERMIT PERMIT NUMBER I i CITY OF ATLANTIC BEACH FNCE20-0013 ,11,...,..., ,_.' .,v" ISSUED: 2/18/2020 800 SEMINOLE ROAD "oF 2� ATLANTIC BEACH. FL 32233 EXPIRES: 8/16/20201 3 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL Notes: Full right-of-way restoration,including sod,is required. 4 PUBLIC WORKS RUNOFF INFORMATIONAL Notes: All runoff must remain on-site. Cannot raise lot elevation. 5 PUBLIC WORKS FENCING REMOVED INFORMATIONAL Notes: All old fencing and debris must be removed from job site by Contractor. FEES DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT BUILDING PLAN CHECK 455-0000-322-1001 0 $17.50 FENCE 455-0000-322-1000 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:2/18/2020 2 of 2 i..L�i;\ City of Atlantic Beach APPLICATION NUMBER ji~ V. A Building Department (To be assigned by the Building Department.) -- s 800 Seminole Road Atlantic Beach, Florida 32233-5445 r� ®� \ ' — Phone(904)247-5826 • Fax(904)247-5845 _r•i31�'r E-mail: building-dept@coab.us Date routed: Z f Z 0 City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: ) (Z ( S EtR LJ ASS �(Z Department review required Yes/No wilding) V Applicant: Pt G-(Y1 RTE PEC.e- ta.am__,1 sing &Zoning-----) Tree Administrator Project: � ( F-EADC-E, • ''--, Public 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 /< v‘ 9 Division of Hotels and Restaurants ��` �� Division of Alcoholic Beverages and Tobacco ceJ. Py Other: c` ��c ma c,- APPLICATION APPLICATION STATUS Reviewing Department First Review: proved. nDenied. ['Not applicable (Circle one.) Comments: , i 06._BUILDIN /� PLANNING &ZONING Reviewed by: ini Date:o+l/Z/2c 2d 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: ❑Approved as revised. Denied. Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 ,o '' - Building Permit Application OFFICE COPY Updated 10/9/18 is il City of Atlantic Beach Building Department **ALL INFORMATION P•,„ iry HIGHLIGHTED IN GRAY �.�.3 800 Seminole Road, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us Is REQUIRED. Job Address: 1621 Sea Oats Drive Permit Number: I' I\CC_21CD 00(E3 J Legal Description r° Vo, 1YA.ar-tn°.. C)(1,-+ (P Lot 7 ()L SRE# 1 7Z0z0-01 30 1 Valuation of Work(Replacement Cost)$ 4135 Heated/Cooled SF Non-Heated/Cooled • Class of Work: ❑New ❑Addition DAlteration ❑Repair ❑Move ❑Demo DPool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial IlResidential • 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) l No Describe in detail the type of work to be performed: Replacement of Old Fencing with New 6'Tall Stockade Style PT Pine Fencing w/Cap&Fascia Accents Florida Product Approval# for multiple products use product approval for Property Owner Information ( ( .C:-° r- Name Todd Wright Address 1671 Spa Gate Drive kL)-(C'L)-(C'City Atlantic Beach State FL Zip 32233 Phone 57-647-4545 C t L E-Mail toddwright7@gmail corn Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor InformationDoss--,,,,c,AVI nC Name of Company Daniel L. Darmata,Inc. Qualifying Agent Address 449 Arthur Moore Drive, City Green Cove Springs State FL Zip 32043 Office Phone 904-333-0981 Job Site Contact Number State Certification/Registration# E-Mail annahel@darmatafence corn Architect Name&Phone 44 Engineer's Name&Phone# Workers Compensation Insurer Associated Industries Ins Co OR Exempt o Expiration Date 17/g1/707n 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 tcrtpB requirenmAs 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 N applicable laws regulating construction and zoning. W N WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT M, N RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INT-I�z o F- TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE E w - o w REC DING YOUR NOTICE OF COMMENCEMENT. 0 m z Uoc�j o �r)�, Avutab-e&Ca Cart-or o < o (Signature of Owner or Agent) (Signature of Contractor) < O Z -, c°.) - U. re and sworn to(or affir ,e+)bef.,e m- 'his L day of Signed and sworn to(or affirmed)before me this '" P 13� , by O , g W LL 0OwW } 4t.naT(+tary) (Signature of Notary) W a - m :;AQP TONI GINDLESPERGER _ LI 0 la W M UJ :+: •�� , •. MY COMMISSION#GG 353178 W V CO W i ' .e rsorrAR,IIRES1,Qat�Rr6,2023 [ ]Personally Known OR 5 cc "••OLr:`41;r8@ 9cThgtdiq icerunden to _ / ]PrQ1; Identification W IIJ 7 Type of ldentifica�tion: ' �1 —��L ADZ peentification: Q • X • • SEA OATS DRIVE • Y (60' R/W) FD.1/2"I.P N89°20'1 WE 115.00'(P)(M) FO.1171.P UI.P 50645 n ■ • QD.T I li ; lo!. I 6.i'� 124.08'(M) FD. P REFERENCE i,I, 4 r, *IV 124.24•(P) MONUMENT 4$S n n 'IV NO I.D. (BY Put) -•-•-• 5�;� l 14#4.4I��I�I N 33.7::; . a 23.4' 3 '.';.'. iso.'. C a EC NTRY < <O H .GONG DRNE-' 5 _F F 17.5'5 0 27.5 1 H ,. 0 E°. I- LOi • O p0.1' :-'22>.<1 h��e;.. .....:i;..:,:..., , ... LO ID .0 —. D.4' 1 STORY FRAME z..• r #1621 za' r—..,U LOT 8 LOT 6 0 h z5.o' r to' m p w E bin V" nOS "�f B•3' 121 0 SS.r . o • �iD ��I�I�I�• m '4 1 0 007 m.0 PAVER PATIO AN% 9, No • 0 h Z o f 1T.9' 16.3' I ISISk��i'.1 a i 2 7 lei W• S'WOOD FENCE 0 0.6' 01�� (TYPICAL}, ' FD.1?LP S89°20'10°W 115.00'(P) FD.1?LP (NOLO.) S89'23'02"W 115.36'(M) (NO I.D.) SELVA MARINA UNIT N0.2 PLAT BOOK 27,PAGES 6-6A LOT 1,BLOCK 5 LOT 2,BLOCK 5 LOT 3,BLOCK 5 UPDATE/RECERTIFICATION SURVEY:10-26-2017;W.O.#2013477-2 FERRET AND AS,SOCJA. A.5'' INC - 5627 A7ZANOC BOULEVARD SUIT EJB , JACKSONVILLE, FLORIDA 32207' (9t#,) 5•sp03�.,-. FAX(904) 805-9888 GENERAL NOTES: P.C. POINT OF CURVATURE LE,GEN-i.�' y Z (1)BEARINGS SHOWN HEREON ARE BASED ORME P.T. POINT OF TANGENCY " 7,7„.�f)•{'ept/•/yy;;•..- , ANGLE/ SOUTH RIGHT OF WAY LINE OF SEA OATS DRIVE AS P.RC. Po:Tigc4VFRSE CURVE •',? .!" ••.; A.,,,:ARc • NSB'20 0"E,PER PLAT. P.C.C. POINT OF CURE C1wvE c erw 0 P.O.C. POINT ON CURVE ' C`W P.CD, r3r"EMCONIROL PORT (2) THIS PROPERTY HAS NOT BEEN ABSTRACTED S ��RESTRIcrnN�vE - '�_,:.�.(�6.5/t6'' AN To CURVE FOR EASEMENTS.COVENANTS,RESTRICTIONS CLF OWN UM(FENCE RAY RFFICBL•WAY --f) I r (3) UNDERGROUND UTILITIES SERVING THIS OAV. OFFICW.RECORDS VOLVME. . ' ((qq�. _ PROPERTY HAVE NOT BEEN LOCATED OR OA. ONI � �• I ''..-1A..../ SHOWN -1- ERF-AK UNE 11T. , • I�t •. (4)ITIS THE LENDER'S RESPONSIBIUTY TO SCALE 1"=30 DETERMINE FEMA FIR.MAP STATUS FOR THE LIFE OFTHE LOAN ONTHE PROPERTYSHOWN ABOVE. 5-21-13 SURVEYORHEREONWILLCONFIRMFOR S`1• ADDmONAL FEE. DATE OF FIELD SURVEY NATHAN P.PERR ,FLA.C RT.NO.690D LB-6715 F. 521 . 75 NOT VALID WITHOUT THE SIGNATURE&ORIGINAL RAISED SEAL OFA FLORIDA UCENSED SURVEYOR&MAPPER ORDER Na 2013-977 otA,yrr, City of Atlantic Beach APPLICATION NUMBER js :jkBuilding Department (To be assigned by the Building Department.) J - "``' ' 800 Seminole Road ECEn _ ��_ fv�1 y Atlantic Beach, Florida 32233-5445 l��t 3 \ Phone(904)247-5826• Fax(904)247- F 4 1 Z/i. riJHi>T E-mail: building-dept@coab.us / 202� Date routed: City web-site: http://www.coab.us DV. APPLICATION REVIEW AND TRACKING FORM Property Address: ) G2. i SEA 0 Pt-rS IIIz Department review required Yes No �` (uildin Applicant: GL(Y\AY CC I— EADC_C (><lanninq&Zoning`, Tree Administrator Project: Cr, ( T C CPu ork (99_ubliciltililie Public Safety Fire Services n < 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 `---k Corps of Engineers 'K. \/‘O� Division of Hotels and Restaurants e` Division of Alcoholic Beverages and Tobacco ceA �,r..`> Other: 425`' e,. 0\ 0. APPLICATION STATUS Reviewing Department First Review: Approved. Denied. Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by Dater-A2-'20 TREE ADMIN. Second Review: I 'Approved as revised. I 'Denied. HNot applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: Approved as revised. I 'Denied. Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 ri.An-rj City of Atlantic Beach APPLICATION NUMBER .4S • „ Building Department (To be assigned by the Building Department.) r 800 Seminole Road `� Department.) Atlantic Beach, Florida 32233-5445 ��L� `©r CO( Phone(904)247-5826 Fax(904)247-5845 44" 01.11 ' E-mail: building-dept@coab.us Date routed: Z/jIIjITi , City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: ) CU Z 1 S CEN C5R-rS girt .,Department review required Yes No (uildinn) Applicant: t, MAY 6 PE&DC..� t nine &Zoning CTree Administrator Project: (� ( ---EK.DCE, °�" • ublic Utilities Public 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 /K, \./\ 9 Division of Hotels and Restaurants ` \Q� Division of Alcoholic Beverages and Tobacco ce-N Q ,9 Other: fie`' ` •••‘ a- APPLICATION STATUS Reviewing Department First Review: pproved. ['Denied. Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by:_,§7' DaterI2 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. I INot applicable Comments: Reviewed by: Date: Revised 05/19/2017 �fI..�,� ,1 City of Atlantic Beach APPLICATION NUMBER r S ^ " 4 Building Department (To be assigned by the Building Department.) -. _, 800 Seminole Road I _ Z©_ (3 Atlantic Beach,Florida 32233-5445 COW t Phone(904)247-5826 Fax(904)247 5845 �r S31>? E-mail: building-dept@coab.us Date routed: Z ( ZO City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: ) C0Z I SE/A CRTS �(f. Department review required Yes No ( uildin) Applicant: 1J r -(Y\R'TC. PE.&DC_Enning&Zonin Tree Administrator E D� �P_ublic W sor�ssons _ Project: l� Fpublic Utilitiei�> Public Safety Fire Services Review fee $ Dept Signature oto , 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 !! `--kArmy Corps of Engineers ,K. `--k v1 SS Division of Hotels and Restaurants c` vo Division of Alcoholic Beverages and Tobacco c Other: e....' g .. a...— APPLICATION STATUS Reviewing Department First Review: ❑Approved. Denied. I of applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: Z` i/' W 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 - Building Permit Application . . City ot Atlantk Beach Building Department ••,‘,1.INOCitikAArKIN 440. $00 Senitnale Road,Atlantic Be.ich IL 11134 1,61. ,,,ilit ri ipo GRA, ,,To rw.wra Phone (904)247.5826 Entail 139iIntoji.Dept kl t 0,gt, t-4 - ,i .—,,..N ,.1••. I 11 Set OsetiONN4--- .- • . ,., . . , , ,-.. eilita.. f1fIcatki++,_*,6, 12),,,4 (4, i ..-A 1, 4,,41-Lig„fl.,* I /„..4..)et.,... 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II"al.1{4t 4s * - tarrgrrot.ti 440$tri.r.a'a.,..awitrri mint t ..,,,,,,,.ei it,,,tit cralarw,Wogic fry g"Ageock isrisas, wttb,otxxy t_-N'AL,Otk•(re.141 A ft SS t AV'". arld At*t Leri.11,Wat W, r ARM Kt *nadd* Oithat Pfatalit then,MeV ba laikfititets1 0 estricherit 41Spra-abior'4,tat 1 ptecotliv tk a'mat Ur t ispa4 tat tt w polik t el w'd Ow,Puy bf.AJA,tiVIPA 1.'4'0",..51:10e-ti 1°V*`,1". 11."'V .. V°v,'0 v h,v t-AA AveiIr otattattevrtent deiteictik dor aterfvrws ito fair-44 Item,pt Ow441-4 ftt amyl t ;(Al t.ht that at th or,lx,,.,--4 r...xxii .30,,,,,4 wurit,,„j b dn., ow, *NO -ifol.00. ,t 1f I if,i 1 y,•.,fi,I,f,1,4? W AttNIN(310 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 RE(flHDIPáG YOUR NOTICE OF COMMENCE MINT ._ T) ..tdiAtoli,k---ii • _ el i 6.14141.tt I i men,. iiia..a owpa,nt 1+0+1; ria,..41160 ir ti,.'°A,..40144.1 .1, 1 a L.Ce'ij..0 44 1. 1 10`0 0 thivitivj -t l' 1 .4. . . 16-0.1404114,4114 # - . - 4 v 4,40.0•4...01$ 4.4.00.. 1011§ia 0 Al V A.' lericAppoidlyek+dller NIA** * • . got nail '`, ( ?as , vg• arcom hp sioNtiweromnimme" .........„-,,, , ,.... .. ._ .. Building Permit Application Updated 10/9/18 - - ) City of Atlantic Beach Building Department **ALL INFORMATION Sr 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED. Job Address: 1621 Sea Oats Drive Permit Number: IVCC_ao 00(i Legal Description &I V c„ I r1r 4 (;) Lot 7, RE# l 7Zozo-ot 3 0 Valuation of Work(Replacement Cost)$ 4135 Heated/Cooled SF Non-Heated/Cooled • Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial UlResidential • 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: Replacement of Old Fencing with New 6'Tall Stockade Style PT Pine Fencing w/Cap&Fascia Accents Florida Product Approval# for multiple products use product approval for Property Owner Information e0.-L( -O Name Todd Wright Address 1671 SPA flats flrivP —��� o e City Atlantic Beach 545 -}�State FL Zip 37233 Phone 1157-647-4F (C.-) E-Mail toddwright7@grnail(-rim Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information DQs-1 VAC Name of Company Daniel L.Darmata,Inc. Qualifying Agent Address 449 Arthur Moore Drive, City Green Cove Springs State Fl Zip 32043 Office Phone 904-333-0981 Job Site Contact Number State Certification/Registration# .._ E-Mail annahel@darmatafPnre rnm Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Insurer Associated Industries Ins Co OR Exempt❑ Expiration Date 12/11/7020 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 tc iB reqq1ernipr)s 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. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YQ;UR NOTICE OF COMMENCEMENT. �/��tL) A wvt c are.L C cGrtor (Signature of Owner or Agent) / (Signature of Contractor) _g_ned and sworn to(or affir e.)bef rem,j his` L�day of Signed and sworn to(or affirmed)before me this day of Z ky t111 � V rl �Jl� ,by • na e tary) (Signature of Notary) i9`�tYvu ;c; TONI GINDLESPERGER • :•, MY COMMISSION#GG 353178 ersor6XR1R Sal,Qatatr 6,2023 [ j Personally Known OR °F[ry�Ard®44311N401410714f+Rilnda. _ 7 [ )Produced Identification ype o senti ica ion: • ( Z3 J OL 84 i ' (1)y pe