525 ROYAL PALM DR RERF20-0193 Building Permit Application Updated 10/9/18
)t~ City of Atlantic Beach Building Department **ALL INFORMATION
— 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
n IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 5015 /67/0/ '49f/'7,f417Permit Number: t..\' RFzo e 01
Legal Description JO- 71/6l7-4i'a?S't Ayli//"4"4,il YAP'?irev74,,�/X q RE# /7/J -C1/947
Valuation of Work(Replacement Cost)$ /Q7,r' Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial ®ft�sidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes ❑No
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) Pick)
Describe in detail the type of work to be performed: /et/ "f j
Florida Product Approval# FL /8'3f5 -// for multiple products use product approval form
Property Owner Information �,� I
Name g RADPoRD MCNE Address 52-5 RO yicc— PA( k4óCSR—
City All.-6k)T(C-' bFA-Ct f State rt, Zip 3 7-2-3 3 Phone /0 If-8194 y/0 y7
E-Mail et /,( rvtcitAA) ca. CU1M.C45 r. (�c f-
Owner
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information �J/,- ',,/ ,�
Name of Company ,,/i,/(�1 .fi4'y�A,s,- "� Qualifying Agent G',egdy � AI/��,*/'if Dy
Address 07y ���/g e City ;TAX / State / 7" Zip LY /
Office Phone O ) (NO '' 37 Job Site Contact N�tuber
State Certification/Registration# GCC /327x'? E-Mail hi//dA y
Architect Name&Phone# ✓
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt PrCxpiration Date a/101040
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
REC R►, G R NOTIC F C MMENCEMENT. —
/ ( ignature of Owner or Agent) (Signature of Contractor)
k.
Signed and sworn to(or affirmed)before me this/3 day ofned d sworn to(or aff m:d)before me th• day of
bcft to RC , 2020 ,by 8 c& O c-Q IV c NQS ,,ADZ 0, by . - _
.
� c � .1:1•:mission St4 y 26
ii�ry TONT •GE
p Expires May 31,2022 .•: 40, s MY COMMISSION#GG 353178
e i o; •*: 'eu:
•-.�!,!;.• Bonded Thru Troy Fain Insurance 800.385.7019 .i^�, c: WIRES:October 6,2023
[ ]Personally Known 0'
[ ]P .e bnru Notary Public Underwriters
[ Produced Identification /
Type of Identification: 'FLD L �7 SO -)&4 I-moo Type of Identification: IN y-SZ -Z9 : - ( I 4c2-
-Z3-2-I
'—Z3-21
NOTICE OF COMMENCEMENT
State of rl.4' Tax Folio No.
County of Dives/
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: 30 - YVI? -07.5--cZQC /4 ry,4/4eet'5 v'"/r v�
Address of property being improved: 5 2 X55 Roy a 1 Pal{Nl 5 Dr P . /T)IaV)j i G Ack 1 � 3 )-2i3.
General description of improvements: /tie -X Jiff"
Owner: 1IZIdp17a MCiVeAN Address: t5 2 5 Royal Pal 015 Pr. A-6/ pc_3 22:33
Owner's interest in site of the improvement: Odi/NCA. /or5�l
Fee Simple Titleholder(if other than owner):
Name: l
Contractor: / / y#'/ fAWC-4m' //
Address: (i7,-74Y,4 9'G 2-ft ✓4, '6 Z ""' 32 f/
Telephone No.: 0161.$1) 3�t--AV' Fax No:
Surety(if any) ��
Address: Amount of Bond$
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 Lienor's 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 ONLY417-td m
OWNER '" v"" "
Doc#2020228973,OR BK 19412 Page 2280, Signed: Sr-CA oWDC G 0 k C N Date: \O -13'ZO 2-6)
Number Pages: 1 3efore me this day of (S c)cp 1n e{i 2C in the County of Puval,State
Recorded 10/15/2020 11:33 AM, )f Florida,has personally appeared P)rl..r}�cp i b, iM.. _NIQ�W
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Votary Public at Large,State of Florida,CoumtKof Duval.
COUNTY Vly commission expires: S -31- �
RECORDING $10.00 ,r1111011.116
Personally Known: ' Q.HFUSTY RIGNEYor
Produced Identification: L D(i IVt Z So- Q(q L i:i rrtis6lon#GG 190226
Ex ires May 31,2022
'•`
1 • dFBonded Thru Troy Fain Insurance 800.385.7