1887 MAYPORT RD RES21-0005 r
s-'''r%, Building Permit Application Updated 10/9/18
j
\•J City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
`'� Phone: (904) 247-5826 Fax: (904) 247-5845 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: /037 fila iea( r--/61 ,-4j( 15Cn+ rLi ')-4 Permit Number:i ES2 H 0005
Legal Description 17 -)--3 _ )-?1 • ) S f r'Dv7r 1-Drs '-i 3 g Ca L i P.RE# 1 i.�0.S/ —OO4o
(Replacement Cost) S 0 0 )4'r3r..��l
Valuation of Work Re lacement $ Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition *,Alteration ❑Repair ❑Move WiDemo ❑Pool ❑Window/Door ` . -
• Use of existing/proposed structure(s): ❑Commercial ®Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes No . EC E IVE
• Will tree(s) be removed in association with proposed project?❑✓yes(must submit sepa tieeeowliPPiermi No
Describe in detail the type of work to be performed: JAN 5 20zi
piee c.�- 0 4r,v t.,9-r,o,v -Y— x:g ,9,win,( SOFA 7?rte
t( +e(^I O r n a-/S,v f,,A C-i.4 /747-e✓zi :'''.
Florida Product Approval# for multiple products use product-approval form
Property Owner Information �
Name o 1111 i fl hc' (? Address i 6� y
7 MG 'Yl (T"
City fin 4 IC r?„-ckch State tL: Zip 3 g,23:5 Phone f (`/m) 5L 6 3 G. 1
E-Mail rn.1 tt147 k 4 ,' i 1 Teta: -CO rA
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) n/a
Contractor Information
Name of Company Bosco Building Contractors, Inc. Qualifying Agent Todd Bosco
Address 2158 Mayport Rd. City Jacksonville State FL Zip 32233
Office Phone (904) 241-0320 Job Site Contact Number (904) 233-0904
State Certification/Registration# CBC 1250212 E-Mail todd@boscocbc.com
Architect Name&Phone# -
Engineer's Name&Phone#
Workers Compensation Insurer Impact Staff Leasing, LLc OR Exempt 0 Expiration Date 08/15/2020
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 ANA + • EY BEFORE
RECO ING;YOUR NOTICE OF COMMENCEMENT. /' / /
(Signature of Owner or Agent) 4 (Signature of Contractor)
Signed and sworritoinz/or affirmed before me this 5-0-day of Signed and sworn to(r affirmed)before me this -' day of
✓ G ✓ , .20)-/ ,by f'C.✓n/'y,r►,-Tr if e-'- fr*•u , .>"•)-1 , by h IN) /9 ''sce,
l./.riles..- ,2! /0.- �•d A'--' e-
(Signature of Notary) (Signature of Notary)
4i1VP. WILLIAM L.POPE ;is+ou ; WILLIAM L.POPE
11 Personally Known OR ;,.: ah :,,_ MY COMMISSION I Personally Known OR ;.; .,' MY COMMISSION#GG 348645
[ ] Produced Identification =";�I��/ EXPIRES:October 19,2023 Produced Identification I;..�-�o. EXPIRES:October 19,2023
?•...ro:; '''ti ie Bonded Thru Notary Public Underwriters
•.2f�;.• Bonded ThN Notary Puhlic ll'vionrr•nr. nn.+f L�nntifi�'ti.,n .....
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of rei-A7 R ID A County of Dt,iv,f
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: 17 xJ'._ )y'j . 107- 6-01/r hers a,/ 3 1zCcA
Q1R 141 +
Address of property being improved: / D �1 /t'11 WaeT It-0
General description of improvements: t- c:),S 1 ij4 i_4'y7' 4---r e-PrlI
Owner 1QQ,4/4/"/ /`i tT�ftFLL.
Address I$S'7 A-y/1)Ar )QD 'A'TL Nle l�<• 3;�z 33
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner) .4'/'9
Name
Address D
Contractor Pt:�s't f,'u,- w ' C&/1"rE'�cii�s ijrx C
Address ,) /Srrl /14p-1a r &O. A-yc.CC n//i Ii i Fi-. 3:1>3 7
Phone No. 5®4— F l v 'j J0 Fax No. /a`) -di 5--Z
Surety(if any) —
Address Amount of bond$
Phone 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
Phone 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 Statutes.(Fill in at Owner's option).
Name
Address
Phone 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): `�fi�tt
THIS SPACE FOR RECORDER'S USE ONLY
Signed:!�f q.WNER r��S fcY9Lr–y /22rc�
Ci DATE // v)/
Before me this ,(day of ikl,`rt / in the
Doc#2021002159,OR BK 19523 Page 258, County o1 Duval,State of Florida,has personally appeared
Number Pages: 1 (C ciYir I v �t,"Tc%fGy herein by
himself/herself and affirms that all statements and declarations herein
Recorded 01/05/2021 02:25 PM, are true and accurate
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING $10.00 ' l
N /fLyEG •
/2
ytcPuslic at e,S-te of C• y G WILLIAM L.POPE
My commission expires: ♦ iiR`,....,
no -� •E. • 1, _.: MY COMMISSION#GG 348645
�p a�.r,tnt`ed� 0.– � �,Bonded
October
�_19,20233
'' O•F .0 Thru Notary Public Underwriters