469 SKATE RD DEMO20-0033 •.rS'')/4." , Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
u j.. 800 Seminole Road, Atlantic Beach, FL 32233HIGHLIGHTED IN GRAY
`r' IS REQUIRED.
Phone: (904) 247-5826pEmail: Building-Dept@coab.us
Job Address: 4 j - k't47- i D /9/9- 6-- ( /t n Permit Number: C-! 'y�
C z C 00 3
Legal Description -3)--c,rj; /7.2 5--2-jT?/P i7 0 f v(ty =1-- tiles < (4,f,//T RE#
Valuation ohk ro k(IRep�ac6mert Cost)/2$4 /ic'"13 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 Isidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes IZ'No
• Will tree(s)be removed in association with proposed project? [Pies(must submit separate Tree Removal Permit) Cghlo
Describe in detail the type of work to be performed:
I/ .T 12-/32 /6'W)ECSe ,)& 1OL/ '/7OV GF (I' $ 6ATHr
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name Ji0A, F"),'41 '`f/ /18-A Address /6 `f'/ e71 /�'C/I .p4" /�74 12CH1 r L
City 4 7�.q.f /L / lac rf State 1-L Zip ' 0--a-3.3 Phone 9s14 -$3-0 777
E-Mail 11,-. / ky /1 77 )'//Hon. C,C,1
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company � S(_
psa a y,GDi� LI/cm t ,.i . v-'-' Qualifying Agent re 91 /'XC.
Address •7j c /L7r/y,f>ter ('P City 37)-A State FL- Zip 5 "„)-.7)--71
Office Phone C)C 4,--a--4-t'^ & .2• Job Site Contact Number </'4 x'33 •--•cn 9 0/-
State Certification/Registration# C, , ../ 1 e/25 E-Mail 7-c- /OD (&:- t C-8C•c4,4)
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurers Ay 0#(..7- -C,Tg ii- I-64f/,41 -L( OR Exempt❑ Expiration Date e71 .----/,--74-- 1
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 B FORE
RECORDING YOUR TICE OF COMMENCEMENT.
i
-` (Signature of Owner or Agent) / (Signature of Contractor)
Signed and sworn to(or affirmed)before me this /7 day of Signed and sworn to(or affirmed) before me this / -*day of
y j c)/�v /52. -
0`.. WILLIAM L.POPE .., . `•";,�; WILLIAM L POPE
• -.• ,k•, MY COMMISSION#GG 348645 .i ,'!`. :.: MY COMMISSION#GG 348645
i A :,Ai cru r
pi Personally Known OR = w��� EXPIRES:October 19,2023 J]Personally Known -.,;e774 ; EXPIRES:October 19,2023
[ ]Produced Identification •...•,• _ BondedThruNotaryPublicUMerwrifers [ ]Produced Identifica n'••••••�"' BondedThruNotary PuGicUnderwriters
Type of Identification: "' Type of Identification:
•
DocuSign Envelope ID. 1 D0CF0BE-D60B-4A40-AEDD-99A5479497AA
A. U.S.DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT R. TYPE OF LOAN
SETTLEMENT STATEMENT
Trademark Title Services, Inc. t ••._FHA 2. FMHA cony.
1845 East West Parkway,Suite 5 ,. v.+ s. COW.tris
Fleming Island,Florida 32003
904-579-4868 fax:904.5 79-4054 a F:�N'°"bcr t.toxo K.r-i,
TM20-495 0148304983
C.NOTE: This form Lc jirrnished to give you a statement a/actual seulentent casts.imams laid to and by the settlement agent are shown.Items marked
__ _ __Woo were paid outside the closing. The)an,drat"n.Arte/nr,tt/Arma{imml puO,ns,-e and Uri nal uu•Indnl to t1;,•'wok
Kenneth Robert Miller and Emily
D. Buyer: S.Miller
469 Skate Road 469 Skate Road
Atlantic Beach,Florida 32233 Atlantic Beach.Florida 32233.__,.._,
Ronald R.Walker •...• ;.._.._........_......
E.Seller: 13800 Herons Landing Way,#2
Jacksonville,Florida 32224
SWBC Mortgage,
F. Lender: 9311 San Pedro Ave.,Suite 100 •
_San Antonio,Texas 78216.
469 Skate Road
G.Property: Atlantic Beach,Duval County,Florida 32233
. lot 3,Block.I8,Royal Palms,Unit 2A_Book 31.Page 16,Duval County,Florida .
H.Settlement Agent: Trademark Title Services,Inc.
Place of Settlement:. 1845 East West.Parkway,Suite 5,Fl::ntiug)slend,Dodd!, 32Q03....Clay.County_-
1.Settlement.Date„; . November 9,2020
J. Summary of Buyer's Transaction K. Summary of Seller's Transaction •
100.,Gross.Amount_Due.From_Buy_e.r____..__-,_.____• .400.Gross Amount Due To Seller:
101 Contract Stele ('tree_,_-•_ 2,
6_,tH)U.(Hl 1111. Contract Sslcs Price_--.. ._.....___ .._....___.___._�67 000.00 •_ ••
102.. Personal Property 402. Personal Property _ _. .._._.__.....___._.__._.
103. Settlement,Charges to Buyer(line 1400) 59.00 403. ..
Adjustments for Items Paid by Seller in Advance: Adjustments for Items Paid by Seller.in Advance:..
106. City/Town Taxes Nov 9,2020 thru Dec 31, 69.75 406. City/Town Taxes Nov 9,2020 thru Dec 31, 69.75 •
2020 2020
107. County./Parish Taxes 407.. county/Parish Taxes
108. Assessments 408. Assessments
120. Gross AmppntDue from Buy_eg: 262,128.7$. .420. .GrostAmount.Due to Seller: ........ 262,069 75.
2011. Amounts Paid.by or in Behalf of Buyer: 500. Reductions in Amount Due to Seller:
.Gt. 1.)cp(};.it i.i•arr:est Money 10,000.00 501., Gxcess i:)cposit i.sce instructions)
712 P.•.:•cipal Amount of;slewLoan 502. _Settlement Charges to Seller(Line 1400) 2L058.15
203. Existing Loan(s) 50:1 f.,,st;:;.,
2(14. 504. Payoff ofFirst,Mortgaee•-
203. 505. Payoff of Second Mor.gage _•
206. 506.. Purchase Money Mortgage
t1s(ments for Items Unpaid by Seller: Adjujtmentsfor 1tems Unpaid by.Seller:
2111. City:Tu.,It•r;x4 51u. C:t,/Town Taxes
I 1 County;Parish Ta ces 51 t. ('cunnty i Parish Taxes,
212. Assessments 512. Assessments
•
220. Total Paid by/for Buyer: 10,000.00 520. Total Reductions in Amount Due 21 058.15
Seller:
MU. Cash at Settlement from 1 to Buyer__ ... 600. Cash at Settlement to/from Seller:
3.)i Groes Amount due from Buyer(line 121,1 262.128.75 601. Caro.•:s Amount due in Seller(line 4201 262,069.75
302. Less Amount Paid by/tier Buyer(line 220) . 10.000.00 602. Less Reductions Amount clue Seller(line 5201 _ 21,058.15
303. Cash From Buyer: 5252,128.75 603. Cash To Seller: S241,011.60
HUD-1 May 2007