835 MAIN ST RES20-0331 „ t r.4,. BuildingPermitA licatian � d ,o8
�t ` -; City of Atlantic Beach Building Department **ALL INFORMATION
\l'‘,;,,,_,.„/„./I800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Deptcaab.us IS REQUIRED.
JobAdd'ress: 835 Main street V Permit Number: Legal Description 18-34 17-2S-29E SEC H ATLANTIC
BEACH S 1OFT LOT3, N 20FT LOT5 BLK151 RE#170944-0020 Valuation of Work(ReplacementCost)$23,000.00
Heated/Cooled SF 1152 Non- Heated/Cooled
Class of Work: ❑New ❑Addition ❑Alteration X Repair ❑Move ❑Demo ❑Pool ❑Window/Door
Use ofexisting/proposed structure(s): ❑Commercial X Residential
If an existing structure,is afire sprinklersystem installed?: ❑Yes ❑No
Will tree(s)be removed in association with proposed project?Hes(mustsubmit se arate Tree Removal Permit) riNo
Describeindetailthetypeofworktobeperformed: pr`7 u itefad,,.i err) /no i:0 3GUzikr cknr,
Florida ProductApproval# for multiple products use product approval form
Property Owner Information
Name JAMES HENDRICK Address 835 main st
City Atlantic Beach State FL Zip 32233 Phone 904 333 9045
E-Mail James00@knights.ucf.edu
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor information
Name of Company Elemental Construction Qualifying Agent Bryce Clark
Address 1716 Harper St Cityracksonvitte State t'i. Zip 32204
Office Phone 904 721 2230 Job Site Contact Number 904 434 3578 _
State Certification/Registration#cbc1256211 E-Mall_ William(a�spjax.com
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer FCCI OR Exempt a Expiration Date
Application ishereby madetoobtain apermit todothework and installations as indicated.I certifythatnoworkorinstallation has
commenced priorto 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,andAIRCONDITIONERS,etc.NOTICE:In additiontothe requirementsofthis
permit,there may be additional restrictions applicable to this property that may befound 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 TOOWNER:YOUR FAILURETORECORDANOTICE OFCOMMENCEMENTMAY
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.
at 41.4,, — .L..alil
' (Signature of Owner or Agent) (SignatureofContractor)
Signed and sworn to(or affirmed)before methis� 1 day oSigned and sworn to oraffirm d)before me this 2_, day of
OG I1 ine , 2 8 t v , b • .LL,- 1--tear tL_ OC bu�-
U , v ,by y(9,_ (.- (6(_%( .
(Signature of Notary) (S' r of Notary
I u+' ESSKA SMITH
',.r �ESKA SMITE I ���+ vc:ery a❑pis-S
.i jY`. Notary Public Stare of Florida , y- tete:`Fonda
y ” Commission$CL 330626 I �o,. Ca--ass:n a'3G?30625
Personal) Known I ' I ,fPersonallyKnownOR ���. M!,-C,-.ExV-esva:9.2923
Y n My Comm.Expires May. 2023 _
MProduced Identification _ _ _i_ __ ,Produced Identification i` `°` --
Bcnred thrcu�vaCcra.Votary Assn. � i - -�-a.vcta-.assn.
Type of Identification:j)(1t!'�(r (.cubv Type of Identification:
VI C2 L. - LI C(4 - cl ) --rt1 () -. r-.
NOTICE OF COMMENCEMENT
State of ice,. Tax Folio No.
County of Cora
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 COMMENCEME Tjj
Legal Description of property being improved: f$-V-1 11- -1'i E. Ser 1-1 14-Iun t►L caClti S _
toFi Lo4-3, Li) 'l , tU Wf� LC) 61-K1S1 _
Address of property being improved: 635 ),lc4F1 or. L;Z2.;"
General description of improvements: "cat// 40a,/5 _
Owner: ��, � t cP�1�r,CKS Address: a33 Ma;el a- H4-tun f•c (ec,CL FL 32433
Owner's interest in site of the improvement: _
Fee Simple Titleholder(if other than owner): _
Name:
Contractor: E l e_m€n+c> 1 Cer1S+r..e-4-;_ ter, r r C\ar K _
Address: 17 Ui I—taxp€J 5* �c_kSQ,L,
Telephone No.:(oQy')71 1 -? LtD Fax No:
Surety(if any)
Address: Amount of Bond$
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: _Jynnrri-irA 1 CollStrvC+icWl —
Address: 171(i Nareef 5- �aGU Aw,11 FL .3L1-0
Telephone No: ('701-) 7ZI -2230 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: 1Ie rv1 e vi-1-c /
, I c I A5 C- h Uri
Address: 171 to Ho(per S� ��ckSov3Li/ //e FL 3220'-1
Telephone No: (low) 71 1 -Z? 3O 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 ONLY OWNER
Doc#2020264664,OR BK 19470 Page 1678, `i.�,,,,,�. -
Number Pages: 1 Signed: bate- —'�
Before me is ) dayof OC loQ� ink. t "sMrr:+
Recorded 12/01/2020 10:53 AM, 1 '4Cl � Ycf�:QylNa,55#aF,eFlonaa
iy� a .cRmission s GG 330616
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Of Florida,has personally appeared J' t„ n 1013
COUNTY Notary Public at Large,State of Florida,County of Duval. �,-cracvccarvass
RECORDING $10.00 My commission expires: G (, 3 3 0 (P Z Co - �^
Personally Known: or
Produced Identification: O\ \VXA( Lk(.a."R-
(-4S34. - '1S9 -c(Z -U�U-V