89 DEWEES AVE DEMO20-0027 BuildingPermit Application Updated 10/9/18
' pp
City of Atlantic Beach Building Department **ALL INFORMATION
., 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
'-'w IS REQUIRED.
gPhone: (904) 247-5826 Email: Building-Dept@coab.us �`f- /�O
Job Address: 01 ,e.,2' ) ,A11-e_AiL- - Permit Number: Iii MOZ0 (- Z 7
!)
Legal Description Wr 7 t ( \uc\i- I-1 DG AN) G!-vire. Vvr)' j.. RE# /&9 563-t '°
Valuation of Work(Replacement Cost)$ S c tr Heated/Cooled SF/ Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair OMove Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial Ljesidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No /
• Will tree(s) be removed in association with proposed prolect? ❑Yes(must submit separate Tree Removal Permit) No
Describe in detail the type of work to be performed:
Demo A-iu a it, how,x- . A00,0,,MAi4j 17 5,6 it,d- cbot-p-,,k'-/LAY sAvr,,e5 . Oh5A-r'J 3fiLgiv,"e
Florida Product Approval# /VIA for multiple products use product approval form
Property Owner Information
Name 44A9;1-4/Iv Lrx•vtllRJ Ow 6) Address .37 /l N Sfi
City Al•t',�-v h t- State rL Zip 31.433 Phone ?O`l- 34?- 203
E-Mail ML {-3,,,v c,) Cvvh.L 5'1_ At"
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company C- r1,4v1k.r 14)n".1,,, Qualifying Agent Lh/i7 t.i-rk loe,'`t5r- )
Address qt) PA-1k)l1-e- (,tr'Jp City , -PAAA-f& G r_tx State Zip ,3049-33
Office Phone C104-1'31I 1 -'01g,,,-5Job Site Contact Number go`/- (J-Zac 3
State Certification/Registration# (2)%'(---°•S 41 t 9'0 E-Mail an, a)e�i+P hi .'-e' -1', Ce vy
Architect Name&Phone# iv/A-
Engineer's Name& Phone# ✓'/,k
Workers Compensation Insurer OR Exempt El 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 FI NCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RE •RDI 4 Y UR NOTICE OF COMMENCEMENTi / • ,'\____..a_... -_E::-_ _________ .
— _r -z/77—>------ ---
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed) before me this,L day of Signed and sworn to(or affirmed) before me this. day of
ldD � 0 v y y .. . w YYl .,-ii On (�C-tober , QQ.O ,=-;�C. Wm.h c'rl
�t•va++rr��Ncracy)� _ (Signature of Notary)
';raYPu..-., DANIELLE WILLIS
2° Notary Public-State of Florida 1 / ot'r '-. DANIELLE
WILLIS
1 Commission#GG080201 J Personally Known OR Notary Public-State of Florida
Personally Known OR --_,-,,.„....z4i. r - Commission#GG 080201
My Comm.Expires Mar 6,2021 `,, Ace,:[ 1 Produced Identification oF °` [ 1 Produced Identification +,�y=� My Comm.Ex
Bonded through National Notary Assn. ,oc Ft, piles Mar 6,2021
Type of Identification: Type of Identification: Bondedthrouahl� Ipotarygssn.
DocuSign Envelope ID:B5498E46-E785-4748-A984-72581AED5D8A
merican Land Title Association ALTA Settlement Statement-Borrower/Buyer
Adopted 05-01-2015
File No./Escrow No.: 2020-191 The Law Office of Samantha C.Joseph, PLLC
Print Date&Time:09/30/2020 10:21 AM
Officer/Escrow Officer: PO Box 26114
Settlement Location: PO Box 26114 Jacksonville, FL 32226
Jacksonville FL 32226
Property Address:89 DEWEES AVE,Atlantic Beach, FL 32233
Buyer: MARYANN GILLIES LAMBERTSON
Seller: SUSAN J MCELROY and JESSICA L GOLDMAN
Lender:
Settlement Date: September 30, 2020
Disbursement Date: September 30, 2020
Additional dates per state requirements:
Description Borrower/Buyer
Debit Credit
Financial
Sale Price of Property 590,000.00
Deposit 10,000.00
Prorations/Adjustments
County taxes from 01/01/2020 to 09/29/2020 4,335.92
Loan Charges to
Other Loan Charges
Impounds •
Title Charges&Escrow/Settlement Charges
Title-Settlement Agent Fee to The Law Office of Samantha C.Joseph,PLLC 150.00
E-RECORDING FEE to SIMPLIFILE 4.50
Commission
Government Recording and Transfer Charges
Recording Fees Deed: $18.50 18.50
Payoff(s)
Miscellaneous
Copyright 2015 American Land Title Association. File#2020-191
All rights reserved. Page 1 of 3 Printed on September 30,2020 at 10:21 AM
DocuSign Envelope ID:B5498E46-E785-4748-A984-72581AED5D8A
Description Borrower/Buyer
Debit Credit
Borrower/Buyer
Debit Credit
Subtotals 590,173.00 14,335.92
Due From Borrower 575,837.08
Totals 590,173.00 590,173.00
Copyright 2015 American Land Title Association. File#2020-191
All rights reserved. Page 2 of 3 Printed on September 30, 2020 at 10:21 AM
DocuSign Envelope ID:B5498E46-E785-4748-A984-72581AED5D8A
Acknowledgement
We/I have carefully reviewed the ALTA Settlement Statement and find it to be a true and accurate statement of all receipts
and disbursements made on my account or by me in this transaction and further certify that I have received a copy of the
ALTA Settlement Statement. We/I authorize The Law Office of Samantha C.Joseph, PLLC to cause the funds to be disbursed
in accordance with this statement.
DocuSigned by:
harttamv i1W fs Vitt ErfiS61- J
8F501588325G D0..
MARYANN GILLIES LAMBERTSON
Escrow Officer
Copyright 2015 American Land Title Association. File#2020-191
All rights reserved. Page 3 of 3 Printed on September 30, 2020 at 10:21 AM