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380 11th ST RES20-0351 - , _, Building Permit Application Updated 10/9/18 .g.''' l r ` i_� .i Qty of Atlantic Beach Building Department **ALL INFORMATION 800 Seminole Road, Atlantic Beads, R.32233 HIGHLIGHTED c IN GRAY Phone: (904) 247-5826 Emal: Building-Dept coab.us lS UIR®. I .bb Pddrec: 3g0 11 Til 57-1 A-7/41-0c:N 13i-AGi"l, rmit Number: RLS 2 G (:) . .S Legal Description c-6,' /6-25-2.6f 4r/At T7C L3'4cf /.vr37C%/Z /� 39 t3C/C /3 Valuation of Work(Replacement Cost)$26'3©O., 00 Heated/Cooled a.95)1 Non-Heated/Cooled 28 7 El Class of Work: ❑New ❑Addition ❑Alteration pair ❑Move ❑Demo ❑Pool ❑Window/Door ❑ Use of existing/proposed structure(s): ❑Commercial dentia) If an existing structure, is a fire sprinkler system installed?: ❑Yes ItiNo n Will tree(s)be removed in association with proposed project?❑Yes(must submit separate Tree eemoval Permit) o Describe in detail the type of work to be performed: r/./f/'E 0&i F/—at % /4AJ- `4r C, 1? Z-37 7 H4D1E 10 2,) 5/b'('6- /Ns7A1c ?Q/i /�CGu6/* Ha/.S& PP Rorida Product Approval# H 2. 0 for multiple products use product approval form Property Owner Information ��tt �/ Name `]"1© AS ��O� idOO- Addresc v //7/,571 ;ra�7'c i '' G,` y32233 City A-7- 7) 4 /-( Sate FL Zp .'/ 3..3 Rione / — _ EMail (lb/'IA1 ) 74(4010 cool Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) _ Contractor Information Name of Company ti ; .�. 'I. C 4 Qualifying Agent .� - Address(}� /g AR t f#svCity A ; ,J crate Ir Zp /f% Office Rhone -47-7- 03 .bb Ste Cont..: Numb7r ' s d .-- r s' a ate Certification/Registration , _ _/, E ,, Mail' 4/ 1/O L r 11 AL roil Architect Name&Rione# I.J p�yOQS C? Engineer's Name&File# _ WorkersCompensation Insurer ORExempt Expiration Date q/22/2021 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 thisjurisdiction. I understand that a separate permit mu be secured for BECIRCALWC FUUMBING S( \JS W81S POOLS FURNACE BOILERS HEA I LF TANKS and AIRCONDITIONERS etc. NOTICE In addition to the requirements of this permit,there may be additional restrict ions 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 all tl foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. WARN I NG TO OWNER YOUR FAI LURE TO REODRO A NOTICE OF COM M BNCBVI ENT MAY RESULT IN YOUR PAYING TWICE FOR I M PROVBVI BATS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN R NANO NG, CONS,JLT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOII CE OF COM M B\ICBVI ENT. I / /, ..7 i (Sgnature of Owner or Agent) " mature Qo actor) Sgned and sworn to(or affirmed)before me this day of Sgned and sworn to(or . -a)tfore e thisay of by 71 iN/! W • Uff�� ' = v . (Sgnature of Notary) 0:" �'� [ ]Personally Known OR [ J Personally Known OR [ ]Produced Identification [ ]Produced Identification . . ., . . Type of Identification: Type of Identification: :: B•, • .5 : •, *: im :. MY COMMISSION#GG 353178 ;r, ,. EXPIRES:October 6,2023 '''ePF ° Bonded Thru Notary Public Underwriters NOTICE OF COMMENCEMENT State of JLO�er��4 Tax Folio No. County of i) VACi 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 stated in th's N TICE OFC MMENCEMENT, Legal Description of property being improved: , 3 5�Z A7/14P-fir 1CAc (-DT 37, el/2. uor 39 Dix /3 T r Address of property being improved: 3 gQ // 7 / ST 1 AT 1/C .L3C4ci( f"'L X32 3 3 General description of improvements: H4 .DI 50/4RD 5/n1,1/6- /NSTAt_Lit 1 OP Owner: 7-005 GUN( t7f`J IAJOOD Address: .? F ; Owner's interest in site of the improvement: !co 0/0 Fee Simple Titleholder(if other than owner): Name: n/ Contractor: 6—OZ. A 5 CL7IJ5�e" C/1(DNCom'/ Address: 63[g At/7- /1!v DZ G<<- vf/ � � 5( pi 32,2_ /d Telephone No.: o '49[ 2/o ) Fax No: Surety(if any) /V/ 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 Lienors 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-'411111111111 Signed Date: 12 /Zo ztJ Before • i84A1 day of -up CIA}xf/24))the County of Duval,State Of Florida,has personally appeared ''''SYN?(Ac& Littooc,) Notary Public at Large,State of Florida,County of Duval. My commission expires: "\1 11-1Zp"rZ Doc#2020283665,OR BK 19503 Page 1593, -pally K n: or Number Pages: 1 aced I en fication: L, L -� Recorded 12/18/2020 02:48 PM, A RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00 Q'"a 4.P60 NotaryAUBREY Public,M.StateLITTLES of Florida Q Commission#GG 259573 rrw�i My comm.expires Sept.17,2022