250 BEACH AVE RES20-0274 -'-'-' Building Permit Application Updated 10/9/18
,4
City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
1t 9r IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us /�
Job Address:-ISO a--\ 'Ave_ �rOr vc-jp,pc.[� Permit Number: R s Z O' - D . 7 3
Legal Descriptions- ow l ..o-a5 -ac\E. PA\.c. L k, 6VL\ 11.k a`d RE# 17( 552.t4
c.Valuation of Work(Replacement Cost)$LA O 5 c Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alterationtepair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Xliesidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s) be removed in association with proposed prosect? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed: W. JW S
�vJ o oaf -Ire",r,-, o••sr o\.A.4- A-
\
A- S v`P ory S stc/"--- (2_ Q\\ A.I
,c1c- \-\ A vY.0 S, ��w�r c>.•s A, 5`�-\ S r..oa"),-1/4,' f-,w, CA-4-wA.N.k s\lE- L.,,-3,--,--\.# 3�v
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name �cN- C c�v.2).--. '' Address QS° �9..c_AC. k- ./-Q_.
City Psk\Ac >,- l c..C, \ State*_ Zip 3-Ra 33 Phone L./MU t \ty 'Ili;6 0
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Companyrm�OlNY- --k...%\A. -C C-\. - Qualifying AgentC,\\c tr\ �, -vrr3.‘,-w,
Address\ FF \,•1oc�..)cur ' . Citiackr_ ., ,or\\)",\\ State CA-. Zip3 Zed")
Office PhoneC\U'-\ 3 SO • k_._a_e( () Job Site Contact Number
State Certification/Registration# rAL3L\a,l01-11 L1 S E-Mailii.v ..o (6-h\36t Ns-x..6\d L Y- c Lr\,e-r.cares-,
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 FINANC G, CONSULT WITH YOUR LENDER OR Ari a ORNEY BEFORE
RE a 'ID a r Y OTICE OF COMMENCEMENT.
(Signature of Owner or Agent) : , e of Contractor)
i F`iv-
Signed and sworn to(or affirwd)befog me this fit; day of Si ned and sworn to(or affirmed)before me this y of
Stili Mi'K 20 - by .:L A.�-J_ - 4P-_ - by ._,, '. •... C .! 11;•
i
fIr ir da 40
(Signature of Notary) ih 16, _ (S nature of Notar2)jli
:;i'jr iy'••. JUDITH BEALL LAYLAND 1i0°t •• JUDITH BEALL LAYLAND
`F Notary Public-State of Florida `F Notary Public-State of Florida
�,{Personally Known 0 Personally Known OR Commission N GG 965840
W ,� ,p Commission N GG 965840 a�
[ j Produced Identifica r`r.,, or'r? My Comm.Expires May 4,2024 1 1 Produced Identification `'.Fprts• My Comm.Expires May 4,2024
Type of Identification: Bonded through National Notary Assn. Type of Identification:
Bonded through National Notary Assn.
Doc # 2020210457 , OR BK 19382 Page 1498 , Number Pages : 1 ,
Recorded 09/23/2020 03:42 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10 . 00
NOTICE OF COMMENCEMENT
State of � Tax Folio No.
County of'.,i� c\
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713
of the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved:5 'l awl \LO -aS -cA414_ i-11(ar C o r,,,x)
Address of property being improved: a SC) .1c2:-)0 GC,- 4jD_ 0.1-‘1\csrlt-\r L: 33
General description of improvements o r,rYu>Z A\\ \AcDd1 C lrn 0S01,,..rte Ln - icy-SSS
T I
`{1!�r \\\ 51 1 migs � 1 t, r,-� �i oL r-A 1 c'.) r•A ct,-•> —
Owner •‘.CV]_ C rcNN)te._;."‘ Address:a5e) 160 CAr.\r1
3
Owner's interest in site of the improvement: \;�.c .y-,�r�g-\ 39:R 3—
Fee Simple Titleholder(if other than owner);
Name:
Contractor. s A ( r r- —
Address:\7j �`'`� , Jr-
Telephone No:•-•\3SO LaLe{0 Fax No: ' :sL\_ \�1r.
Surety(if any) —
Address: Amount of Bond$ —
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 •-_
�• L1ClZ
SigF ed: Date: � 1
Beforemf1'is' '3 - day ofo�AO
aintheCountyofDuval,State
Of Florida,has personally appeared c.r...Cr-c.e
Notary Public at Large,State o �'�'—
rl "' JUDITH BEALL LAYLAIO e .
My commission expires: ''+
Personalty Known: '��:. •
-
Produced Identification: '. . :' eyianm_fyP( a . •
IBonded through National Notary Assn.