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2011 beach ave RERF20-0213 Building Permit Application � Updated 10/9/18 tjojk, City of Atlantic Beach Building Department **ALL INFORMATION .f i 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY n� IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us RE n Job Address: XU/� � /� ' cA f3-L , / C K �Y' evc, A: Permit Number: I�ERFZC? d 02 3 Legal Description AS- —''3 %3' '-2,S' —29 G .,i2 A) 14tia.44it RE# 109707- 0000 ,_ „; h tiNJ t n / P el e) rhe Valuation of Work(Replacement Cost)$ _�_�OU Heated/Cooled SF Non-Heated/ooied • Class of Work: ❑New ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/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) Ao Describe in detail the type of work to be performed: I w,i �l e /� e P74c_4 _ S k I n J( 'e Florida Product Approval# S7 I / ' d / 7 for multiple products use product approval form Property Owner Information Name (1-c-,k, e Address .10/I 2€uc.I A/•-e .�2© City AO-4k_ ttick FI State Zip ,72-233 Phone E-Mail boor Y) (,v e l j e C,,vvt . l 'Cpv)1 Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information C Name of Company r-& !3 S 2 5S IC / 4'�•Lcqualifying Agent / .0(40i, �. S'i%�•dr Address 3GSS L_f'E? i;, ,cc•r �i City C.riohvi/rxx• State /,. Zip Office Phone 'f - 7 —CiS`t3-3 Job Site Contact Number `e-lY- /`-civ ol? State Certification/Registration# QC.--`{"' 115! E-Mail / Pct Si,ec'c 6 hi Q7/„co Ark Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Insurer X' "p/c-- OR Exempt Expiration Date S'llv�2/ 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 RECORDING YOUR NOTICE OF COMMENCEMENT. (fa� ignature of Owneer or Agent) (Signature of Contractor) Signed and sworn to(or affirmed)before me this 7day of Signed and sworn to(or affirmed before me this 02 day of 16.2.6,by ,- 3 .. .fir, , ac O' ,by / 0 _ 1 •. re_ ',fir r,kc "Z.y'"B`'•_�.°�"._'_:_'_ /54n at..rc of Lint,ru�- s � • A y• • q ROBERTSON :i°•' '4� lr3Y?�''••JANMAURICIOWALKER ROBERTSON • <_� •• MY COMMISSION#HH 009325 ?g' °`r': • EXPIRES: •June 11,2024 • '= ' ' MY COMMISSION#HH 009325 [ ]Personally Known O' `- oFF`o?: [ ]Personally Known OR ;;�� •o EXPIRES:June 11,2024 Bonded Thru Notary Public Underwriters -Fo ,[/]'Produced Identifica. ,[Produced Identification/� dd"e. Bonded Thru Notary Public Underwriters Type of Identification: /•;,/• _ ' - Type of Identification: Qr NOTICE OF COMMENCEMENT State of Tax Folio No. County of 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: /S=Q3 O 9 2S - 2.. 76 a 2-2- Al fii/k.41r'C R'f c&c/; uh if No 3 PT LbT 6( _ Address of property being improved: o C // ('4'G. i 4- G.,e, 4A-41`f 'C g r'G'c/1 1' , General description of improvements: 12._e/ /Q C.e h.Oaf' Owner:Sj;,;,(e7 11 Address: 20//sifeccc/t ,(vf l97L/a.,t)/ C 'fc<cti A7 Owner's interest in site of the improvement: 2.2.23? Fee Simple Titleholder(if other than owner): Name: Contractor: 7 tij 0 _ _ Address: 263 S L e �' cuvi,� / , J (�S��h v/I�Y/ ~7Telephone No.: `/G"4` 7 -r` 1'012 Fax No: Surety(if any) Address: Amount of Bond$ Telephone No: Fax No: Doc#2020265219,OR BK 19471 Page 1769• Number Pages. 1 Name and address of any person making a loan for the construction of the improvements Recorded 12/01/2020 03:11 PM, RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Name: COUNTY Address: RECORDING $10.00 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 Signed: Qv`� C^���� Date: 11/2 7/2_0a-C7 Before me this �., 7 day of it/c.),..,e,M bey-2,..3ethe County of Duval,State Of Florida,has personally appeared .f-rG..lex wt I Notary Public at Large,State of Florida,Count of Duval. ;k.ii. � JANMAURICIO WALKER ROBERTSON My commission expires: June' /( 2.02-4 •: MY COMMISSION#HH 009325 Personally Known: or Y ;•7'..4.7,:;:7; EXPIRES:June 11,2024 ,c.e.-,sc '.f. f°'• Bonded Thru Notary Public Underwriters Produced Identification: �;�,ps