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332 4th St RES18-0399 change of contractor permit application NEED RECORDED NOCtsuming Permit Application City of Atlantic Beach Building Department "ALtANFOR I'VIAT 7' a 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY . : Phone: (904) 247-5826 Email: Bui1dJng-Dei p1fq)qoab.u,, IS REQUIRED. .Job Address: Permit Number: Legal Description J/Ji7ZI E# let-, Valuation of Work (Replacement Cost Heated/Cooled SF 15-!T—f Non- Heated/Cooled ® Class of Work: 1156lew [--]Addition DAlteration ©Repair lElMove !':]Demo OPool []Window/Door • Use of existing/proposed structurefs): ElCommercial t6esidential • If an existing structure, is fire sprinkler system installed?: ElYes X'No 4 VVIII trpe.(sl be r tion Describe indetall the type of work to be performed: 10,1 s4 Florida Product Approval #'' for multiple products use product approval form Property #owner lnforrriation Name Lt J --^'V"( Address- 4 '4 City st�ate -L ---. 7-i P Phone E -Mail k 4 Jet, 2# ------ Owner or Agent (If Agent, Power of Attorney or Agency Letter Required) Name of Company X111 0 7*4 tr�_- 105 --nEle P�ualifying Agent WY: Address-L�Y A--&A�- city State Z i., C. Office Phone Job Site Contact Number 4 E- ail State Certification/Registration 4-C e 44 -q4 Architect Name & Phone # Engineer's Name & Phone Workers Compensation Insurer --- OR Exempt it Expiration Date --- Application is hereby made to obtain a permit to do the work and installations as iv - 11 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 rneet 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. IF YOU INTEND TO OBTAIN F1 / ANC MGCONSULT WITH YOUR LE 0 NA EY BEFORE RECORDING R NO�)CE OFC E CEM T, (S gl)atkO Owner or Agent) re of Cortttactar) Signed and sworn to (or affirmed) before me this ------------ , by (Signature of Notary) day of Signed and swdKto for affirmed) before me this _ day of -------- a - ----------- - - � by___ __ t Personally Known OR )Personally Known OR ( Produced Identification I Produced Identification Type of Identification: Type of identification: (Signature of Notary) NOTWE OF COMMENCEMENT State of mP4__ 'To Whom It May Concern: Tax Folio No. ' The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 ofthe F|oMdaStatute4the 0d|owin8information iss�tadinthis NOTICE 0FCOK4yWEN[EY�ENT. Legal Description ofproperty being improved: 41 Address of property being improved: General description of improvements: N til/'0"p Owner's interest in site of the improvement: FeeSimple Titleholder (if other than owner: wame� cuntra Telephone No.: L'Iz? 7 Fax No: Surety (if any) Address: xmo nt of Bond Telephone No: Fax No: Name and address of any person making a loan for the construction Of the improvements Phone No: Fax No., 't I ff 3 ;%� 0� = Name ufperson within theStateofFlorida, other than himself, designated byowner upon whom nudcesorntherdocu be served: Name: n / men�smay Address: Telephone No: Fax No: in addition to himself, owner designates the following person to receive a copy of the Uenor's Notice a 713.06(2) (b), Florida St atues. (RU ioat0wne�xop�on) � provided � n Section 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 THIS SPACE FOR RECORDER'S USE ONLY OWNER Before rn� this day of in the County OTD-uvalState Of Florida, has Personally appeared Notary Public at Large, State of Florida, County of Duval. My commission expires: Personally Known: or Produced Identification: