955 SAILFISH DR - RES20-0275 -- ' ' Building Permit Application Updated
' - ._ City of Atlantic Beach Building Department **ALL INFORMATION
s:.r / 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRE—D7.
Job Address: i 55- c ;l�s1,11o.- At +4_ , , 033 Permit Number:ES Z0'E `- O ! 5
Legal Description ;Za),wl °s,lr►,i �r>-i+ ! <of 36 61 k 4 RE# '- [?l a,S 7 -avaa
Valuation of Work(Replacement Cost)$3o. Heated/Cooled SF b?c a Non-Heated/Cooled
• Class of Work: ONew ❑Addition J$1Alteration ❑Repair ❑Move ❑Demo ❑Pool OWindow/Door
• Use of existing/proposed structure(s): ❑Commercial (Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes XINo
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail �.hthe type of work to beLperformed:
,eve'. ) ' `T?,,,-,y r 7270 c/i70(-4‘, ,.0 n -1
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name 1.-kc r".6.5 ti, A a`n f-t rte-) Address 134.5( f -ilar•c.e-1/4. .f>.
City„s117,_,,A6aYw i�ge State Ft Zip 3,2072:c— Phones c-1J G 16.- Q i`ld
E-Mail ec�alT°r. 1 it LicS*<►'),,,L11... Com
Owner or Agent(If Agent,'P'ower of Attorney or Agency Letter Required)
Contractor Information l l
Name of Company j!)-)G ki.
43 ,1 -,,,i c,.r- ! +;.6.y1 Qualifying Agent ;�k,c,es re-- -t rN,
Address Pa $-6 4 `.) City 4=,,,'}'^e.. %4 State F / Zip 3g od 1-
Office Phone(94=-4)85 - I 1 4 '1 Job Site Contact Number
State Certification/Registration#CAY= l d o G E-Mail •..,Scxkl- Sot & /(r�;vt .Cin.
Architect Name&Phone# J
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt Expiration Date j/, c-/a SZek-/
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 Yrs R PAYING TWICE F R IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAI . NANCING, CONS ITH YOUR LENDER o • AN ATTORNEY B RE
RE-0071: YOUR DICE O MMENCEMENT.
0'
(Signature or toner ., (Signat - • Contractor)
Signed and sworn to(or affirmed)before me this()-eyday of (Sined a • sworn to(or affi �`:)be 're m- thi .qday of
5.-(12.1-1/A4-4,-,a-0 d.,o ,//by el; ////���Ce n r�\ _P 2z;0 • �' l 4 'o
l O _ o.......... TCN zvji - `-..-.,Nal
Si:nature of Not. o i( ��
.. - :• MY CCM • • rc 1.4
„: '
•;:;� KEAUNDRAHAWKINS :.,r.,��`.P EXPIRES:Ocioher 6,2023
.R y ._Commission it GO 352294 ',,.`?' Bonded Thru Notary Public Underwriters
[,' Personally Known OR '--..;;;7"..a7' ' [ ] P
�'o Expires July 7,2023
[ )Produced Identification '••`.':•:.'' Bonded ltwTroy Fain Insurance 80038S-7019i l Produced Identification
Type of Identification: pe of Identification: U ,
NOTICE OF COMMENCEMENT
State of tk r .,cat c` Tax Folio No. R ' rli OZ 5-2- a a b e)
County of 1 ),�,>Q_-t
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: p��i t-.=L(w.yv s uL y,,,,t I I($÷3 6 k C
Address of property being improved: 16- 5- .c..-, (,-i,i5 i Dc At k,,4-; , .&4k f i , ` .A33
General description of improvements: /Y+,r ;wr A (+e,r 4--i,an,.S
Owner: -rr Pc Ar,N Fe n n e / Address: 1S6,77-1 Price to/'` $ 1 - I
Owner's interest in site of the improvement: f-e Si'„v l e 32.2.2 s'
Fee Simple Titleholder(if other than owner):
Name: /' L
Contractor: J CrTh I�L� ,. )ci, ny C�(^Q�f' / ,-f/v��. �(�)" e.--7.)---.\ • C54=?-...S.C1.Y'1
Address: P x S-6Z ar- V e C6 r - 'Een. )1- c 3.3av4
Telephone No.l'?)&a-. //Ye/ 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 recel‘.. . ‘-^^" ^F •" -- "-.:__ __ • . . • -
713.06(2)(b), Florida Statues. (Fill in at Owner's option) Nuc#Numberr Pages 1ages 14,OR BK 19389 Page 27,
Name: Recorded 09/29/2020 01:14 PM,
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
Address: COUNTY
RECORDING $10.00
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year trom the date of recording unless a different date is
specified): _
THIS SPACE FOR RECORDER'S USE ONLY OWNER
EC1/Signed: • �`�/`,L A.,-,,AL. Date:CV �bZ
Before me this day of ' - o ahe County of Duval,State
,.0KEAUNDRAHAWKIN$ Of Florida,has personally appeared "Ce A Fermw
f. ;;Commission Notary Public at Large,State of Florida,County of Duval.
.• • Expires July 7,2023 My commission expires: / ul K ?, 9'0 3
•.'"f:.' Insurance Bonded Thou Troy Personally Known: �/ or
Produced Identification: