45 W 8th ST RERF20-0180 • Building Permit Application Updated 10/9/18
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rr City of Atlantic Beach Building Department "ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
toj;�� IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
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Job Address: 4.5 ���+ `> � — Permit Number: I�E�FZO �I 8�
Legal Description j 3i/.3� 5� 1 �,�►r 't t ���� 1 L1 rG('I"3 y RE# /]4°JG,j -OUtJt,
Valuation of Work(Replacement Cost)$ -.-SO(OJ Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition DAlteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): C''Commercial ❑Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes L7No
• 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: /2.4/24;v4-- -7 ytti�' Sh, ✓��js 1/'/� f)r /1/
j�r�
Florida Product Approval# � �� .:.r / _3,,i. I for multiple products use product approval form
Property Owner Information
Name (,v; 1I//'ski P ..+z/t Address I" t1, S L t''f
City (41-1/)w 1).c L State jam( Zip 3211.; Phone 3q!,'"-753 Ml.f4
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of CompanyJ'A rt /.24,41::,;u4 (t Qualifying Agent -52c✓C
Address 91_13 /1 t' 4-✓t S' J City 57:1-?,./3 LJ) State (=--- Zip 7221 Q
Office Phone ny- 4d -IA L Job Site Contact Number 4'C*-.1L4-) y r r
State Certification/Registration# C;C'C L c'L gi( E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt❑ 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. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING O C 9FF� MENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
•efor a his�' day of Sigrtgd and sworn to(ora r •dl)before me,this of
f P.d•ir s►�:.: 1 f lJt�� 1C' .7.ozn,,b 'tom' ' '� or
4�" Commission e G.� _,� �� ��, ! U C � V A
'• M Comm.Expires'"4.2021 (Sry)
,,�.� Y nature of�a ��(Sign�re ���''
:'••;;�: —
.,. 8on�eCihrcughNaticrtiNct2ry+lssr. `
'i1AY PU'•.
[ j Personally Known OR I I Personally Know -°'���ti� TONT GWOLESPERGER
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MY COMMISSION#GG 353178
L ;rFo.�`oc; FIRES:October 6,2023
Bonded Th,v Notary Pubic Underwriters
NOTICE OF COMMENCEMENT
State of f' Tax Folio No. /70 763"
1xJ
County of l.,(J✓1'1-1
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 Description of property being improved: ! Y—33V 3 -As ?1`7/� hf-14.q.c.- /3ltyr , 5 i4-
-0t- 6 L2)/l(-3 5 1
Address of property being improved: /c 1_,s//f)- v*L S./ / 1-14Ar "c13r-< .(<- [7 -33
General description of improvements: I Ilir_i -
Owner: t✓, 1,rtiflvt fT) ,i is /( Address: L.5 r:,/tjF 'o'f'f' 4444,.,k (?//,I/-3-12_,273
Owner's interest in site of the improvement: Doc#2020212457,OR BK 19385 Page 1535,
Number Pages 1
Fee Simple Titleholder(if other than owner): Recorded 09.25;2020 02:27 PM,
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
Name: COUNTY
ocRECORDING $10.00
Contractor:,$)1G✓i /7w l;.' ' (1<<
Address: `}1.9 i 2-1-1`J/4 4�Cx 4-I J A-.if i i l_A Ft' 3 6
ikily
Telephone No.:q,,i, l VyL. Fax No:
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 Lienors 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
;;r�'o PAMELA JEAN SHOREAl' ���
¢, Signed: i �./ 1 Date:
,' 1^= Notary PLblic-State of 5br da x t/i' the Countyf Duval,State•` • Commission t GG 153592 Before me this day of ir =ry�• Vfi
"",+�,girl MyComm.ExairesDec 4.2C2' F Of Florida,has personally a , rhe. (1:.,n
p y ppeared Y�� f�! l 0' �
il .'Eos, '. Bo,dtdMrouchtiaticralqctaryAss- NotaryPublic at Large,State f F orid Co of D val. r /
. I
My commission 7 C7 mission expires: l �50s9 (1Dec
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