543 AQUATIC DR - RES20-0332 11/30/2020 IMG_0002.jpg
=, ''lv, Building Permit Application �- \`" �-�
Updoted 10/9/18
-rt City of Atlantic Beach Building Department
�' **ALL INFORMATION
33�; 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us is REQUIRED.
Job Address: ) A u/b.,e._ Pe•
Permit Number: 1`E2v ' 033Z.
Legal Description V- 7) /7 -ZS- 2-9C � c C�I�YlnOAti1 Lfir 27C
� ' RE# 17/f3/�s 3Zb
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Valuation of Work(Replacement Cost)$6 J` CA49 Heated/Cooled SF
Non-Heated/Cooled
• Class of Work: ONew ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo DPool OWindow/Door
• Use of existing/proposed structure(s): ❑Commercial ❑Residential
• 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) ONo
Describe in detail the type of work to be performed:� y _
l i(0/Zi� /1/G'(/r//r , u/)G"/rG to/can/314 ! G,cLh21C — I ) other-
7C F ucS 1 �l
(-7,....,,,-,43- t S(44.3) CFr ,.> •f,{w,..s„Oaf(er3isc-d'• $)
Florida Product Approval# t'
for multiple products use product approval form
Property Owner Information
Name// , ofvt,/t - Address A) /742142(Zgl.vQ_
City Z','" tt)14 6%)90) State
(1— Zip 32„0$L Phone MY • Y i)--C.)/.1--
E-Mail /}7/ IZG(.4:71,441).. & 6m47L• 1O'4-
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Companye/V /t /y L
Address 2$35 �,2G3 Y L L�t� Qualify�g Agent �/(l!,?•0 1(30o
A./ , #/o/ City Mtn
Office Phone yo7-3/Z-7/< r State� Zip 3Z�j0 5
Job Site Contact Number .32.(-7T c.(—Z�(&3
State Certification/Registration#C6C l S 1775 y E-Mail <SCz 20 30 L
Architect Name&Phone# •64-(oo- cr nn
Engineer's Name&Phone#
Workers Compensation Insurer g,2(O4 IEA-0 EnVioY4,15 /NS. eel
OR Exempt o 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 FINANCING, CONSULT WITH YOUR LENDER ORA TTORNEY BEFORE
RECORDII� • �� OTICE OF COMMENCEMENT.
CC
.,..,.Th/
(Si! " of Owner or Agent) °
(Signature of Contractor)
:red and sworn o r ffirmecl) .efore me this-�v day of Signed and sworn to(or affirmed)before m- : is 1__} day of
,' ,�
,...:(�'KpnatW607 Na,, : I+1 INS l
F. a•".` Notary
gv,a-a Public-State of Florida
01/ Commission:GG 348395 )(Personally
/ Notarycy Kay
Personally Known OR ""Y Comm,Expires Jun 25, i � r)G Personally Known OR .• ^S"7 ralp
[11 Produced Identification [ '� ` j rnh�i�rtCo (�,p O14D61,.
Type ]Produced Identification fie skiff' &Ole 0p/fp 3
of Identification: _ Type of Identification:
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11/30/2020 IMG_0001.jpg
NOTICE OF COMMENCEMENT
State of 644/44 / 7/dig S"'gge
Tax Folio No. l/
County of DvV/t-
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:
3¢ _ )l /2 - .24 -24e theme. 444404 co- 27 - C _
Address of property being improved: sW,3 ,1/4192-71 1D,41, / Am-Ape_ 1 g- 322 3.?
General description of improvements:
Owner: A(Cf x(.1,7-/42 Address: C /`l ,4.(.&1&
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name: —
Contractor: ,20A/ BO NC-
Address:
i/C-
Address: Z$7355 `CiA 3t/ 6./e- /t1 � tt(o f PAt n &lYt r-L 3Z 905
Telephone No.:1/67-3/1 7 1 ( 9 Fax No:
Surety(if any)
Address: Amount of Bond$ _
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 ONLY OWNER
Doc#2020266306,OR BK 19473 Page 924, Signed: Date: l/ -3U •
\ 1d
,� O
Number Pages. 1 Before me this O% day of iai,.4 U 1l rt lin the County of Duval,State
Recorded 12/02/2020 12:56 PM, Of Florida,has personally appeared ( ritrOIPI17. . _ _
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Notary Public at Large,State.f Florida Count , t. KATIE FRANCES HIGGINS
COUNTY My ex commissionIre :• 1` '• •
RECORDING $10.00 p ►� - : Notary Public-State of Florica
Personally Known: ', Commission.
Produced Identification: My Comm.Expitm Jun 25,202.'
1/
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