630 SHERRY DR RERF20-0214 '. Building Permit Application Updated 12/8/17
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City of Atlantic Beach
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tq - 800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845
Job Address: (93 SA 'r 7 i)" Permit Number:r' e.--RFZ0 - OZ ( 4-
Legal Description, /(. IG d5'-aiL S4/# 4r/ZJ 1,on 03 14(-93 RE# /7O4a(- r3Od
Valuation of Work(Replacement Cost)$ 9360 Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed: l
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Florida Product Approval#f( t7j H /' '5Jkz-s i for multiple products use product approval form
Property Owner Information
Name: fkV Sc.bQf fa _ Address: �)OS4Jfy 0"-
City i'► ,��t(,_ i3 4 State /-----( Zip 32133 Phone q//-37 S,S4?7
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information t� CoName of Company: st YjRc �d 1,,�/G 1Qualifying Agent: �/�p�/;�_ 4ort
Address qa9 f j)"t V City ``7 (/3L•,G� State Zip 322 30
Office Phone 9014 _ `fit LI? Job Site/Contact Number Ctdy- to' 2 S I
State Certification/Registration# CCG 03'1 g I I E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation
Exempt/Insurer/Lease Employees/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 regulationg
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
RECORDING YOUR NOTICE OF COMMENCEMENT.
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(Signa of Owner or Agent) (Signature of Contractor)
_+ _�includi�contractor) l
�ign-,c a,c1s'wo.. ^. fe ec'lifore me this �C/day of ' ed and sworn to(or a ed) • •re e this day of
' v/fMiQ t ��Floridap I �,{ I `'Q ,CL��Z�), ' ' �.'/I ` j `r L Z
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ture otary)
..^...ems! --
•':a,,' TONI GINDLESPE'ER
[ ]Personally Known OR Personally Known OR i'?''- MY COMMISSION#GG 353178
['Produced IdentificationU .2 [ ]Produced Identificati ,. ,: EXPIRES:October 6,2023
Type of Identification: Type of Identification: I �Fer°'" Bonded Thru Notary Public Underwriters
NOTICE OF COMMENCEMENT
Permit No. Tax Folio No.
State of Florida, County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement.
1. Description of property(legal description of property and address 'f available):
la ' -,�2ei /��,�A._cc cc¢►`„.) G3LnfEa 4.10SyiuryA7691/%v4<3r �F/3u,3,3
2. General Description of improvements:
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3. Owner Information:
a)Name and Address: (1 9c 5'{-6Sf0 G o-fitcr tic 441,-)v1.j3t- 1, F I .3 2...2.3,11
b)Interest in property:
c)Name and address of simple titleholder(if other than owner):
4. Contractor Information:
a)Name and Address: tLl lj,✓S Co 39 /24-AAvt-,5` J 4cqe_/1 >=/ 2L5
b) Phone Number:
5. Surety Information: Doc#2020265022,OR BK 19471 Page 833,
Number Pages: 1
a)Name and Address: Recorded 12/01/2020 01:47 PM,
b)Phone Number: RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
c)Amount of Bond: $ COUNTY
RECORDING $10.00
6. Lender Information:
a)Name and Address:
b)Phone Number:
7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13 (1)(a) 7,Florida Statutes:
a)Name and Address:
b)Phone Numbers of Designated Person:
8. In addition to himself/herself, Owner designates of to receive a
copy of the Lienor's Notice as provided in Section 713.13 (1)(b), Florida Statutes.
a)Name and Address:
b)Phone Number of person or entity designated by owner:
9. Expiration date of Notice of Commencement(the expiration date may not be before the completion of construction
and final payment to the contractor,but will be one(1)year from the date of recording unless a different date is
specified:
WARNING TO OWNER:ANY PAYMENTS MADE BY THE OWNER AF 1'ER THE EXPIRATION OF THE NOTICE
OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART I, SECTION
713.13,FLORIDA STATUTES,AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR
PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SI1'E
BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF
COMMENCEMENT.
Under penalty of perjur , I declare that I have read the foregoing notice of commencement and that the facts stated
therein are tr o the est of my knowledge and belief.
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Signature of 0 or Owner's Authorized Officer/Director/Partner/Manager Signatory's Printed Name&Title/Office
The foregoing instrument was acknowledged before me by means ofp}tysical presence orlon 'ne notarization,
this l,viay of /10 V , 20,30 .1:13,1)(/ Cas Q D lrU hO 4i' �(.�{J
w o is personally known to
(N e of Person)
me or produced ,a•L as identification, as
(Type of Authority,e.g..officer,attorney in fact,etc.)
for
(Name of Party Instrument was Executed for) _. ,li/ i
TAY PUBLIQ IGNATU –STATE E OF FLO A
1 „,•.‘„,,,,,, PAMELA JEAN SNORE Commissioned Notary N .5 /7<-
'?�-': Notary Po,c-State of Florida � [ ►��� �!
Commission w GG 153592
4 _1y1V�Cg�m���m}.,E�xxp���irr�Dec 4,2021
1 ( ,.,•'•arYgo}Wn000ir^anu"a1NOUryAsu+. I
Revised 1/1/2020