1811 SELVA GRANDE DR RES21-0029 Building Permit Application Updated 10/9/18
1 City of Atlantic Beach Building Department **ALL INFORMATION
A--01119,- 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: / I/ (19)1.14. 6rrrS1tSe Ara ]�'/. ,Qok Permit Number: RCSZ ( O O Z ci
Legal Description 3 °01,1'O4t.. )J .a 9e- J1v-a b tcc( Lc.11 a/ RE# `6?,4-!4 -3o
Valuation of Work(Replacement Cost)$ 620/c..)00 Heated/Cooled SF Non-Heated/Cooled
• Class of Work: ❑New ❑Addition 111 teration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial C esidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes La11�o
• Will tree(s) be removed in association with proposed project? EIYes(must submit separate Tree Removal Permit) 1A--o
Describe in detail the type of work/ to be performed: /
k.-BABA Geyn e! DQe%l ioft1 7/ ) s P.
Florida Product Approval# /l/ for multiple products use product approval form
Property Owner Informatio II
Name xt42s /ntsIi e -/�l*/ e use FL, Zip 3.3.a-43 3 Phone ?041. ri e2f7 Cr
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information fc r/ ///
Name of Company /p''�','Vin any_ &,1L!i1,LLC Qualifying Agent '7"ocJc1 /J//oa c y
Addressl3 8a26/le, 4).)low W cy]Fe{ City Sites State IL Ap 3,p,p.71/
Office Phone ?j01(• 6 6a Job Site Contact Number ,014
'/I • c2 S4/5
State Certification/Registration take Ara 6;6'3A E-Mail 7Ic, a► Cir •lurrrc'c . e da?
Architect Name& Phone# CO _
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt pi-Expiration Date `0/7/a/
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 BEFQRE
RECs : NG Y! R ► OTJCE OF COMMENCEMENT. ( t / , /i//
L-141(.0-e(!)
• (Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmed)before me-this I`I day of Signed and sworn to(or affirmed)before me this I 1 day of
join Luke) , 2o21 by Do�.,I..s M..t;C. JG(11it-ti ,"14)
(Signature of Notary) (Sign-tu .q
', SHANNA L THOMPSON
•�' NotaryPublic•State of Florida
PersonallyKnown OR �`*€
[►Personally Known NotaryPublic State of Florida [ ) '
t Commission#GG 985912
roduced Identification
t+rr4 '`
[ I Produced'dent& io Sarah A.Callaway �N' 44 Comm.Expires Jul 1,2024
Type of Identification. MY Commiasron GG 987945 Type of Identification: r I t t I
{x0iros tM1t3 �
NOTICE OF COMMENCEMENT
State of Fi,-7c09 Tax Folio No./4cr5-'3 2- ,1-c) y a
County of id., y-ct,
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 COMMENCEM NT. a
Legal Description of property being improved: $-a$ al -a"5 a 9 c'e/V cc ' '*Cote Lc, / (
Address of property being improved: /$'/( 19/P'4 (77A.AcIe #4t7 11Y'/`e_ s0 A j/ L aao13
General description of improvements: /k' T02PIL /P,naJO/, )1 005 e te//A?a ie
#/J
Owner: IVa a S lnu b(� �i.M�'�/ rival- Address: / Se /`4 &/'oAc a r+
xiollZ
Owner's interest in site of the improvement: /00 16
Fee Simple Titleholder(if other than owner):
Name::/ /
Contractor: A'('�tofr( eom,a y' �i,p,.y L 0 f
Address: /3 zrai 449) '1/e."-‘,)k '1/c It"c c/
Telephone No.:gOa.1 ,e4c7.07T-/3 Fax No:
Surety(if any)
Address: Amount of Bond$
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: /o r ` lav [l.D WI
ll/
Address: /a o ` veto I` ).`/<oc•i 1111u a X 1L a a a ad{
Telephone No: 70s1. ad. Q? Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice478,
as provided in Section
713.06(2)(b), Florida Statues. (Fill in at Owner's option) Doc#2021062652,OR BK 19624 page
Name: Number Pages: 1
Recorded 03/10/2021 12:38 PM,
Address: JODY
COUNTY PHILLIPS CLERK CIRCUIT COURT DUVAL
Telephone No: Fax RECORDING $10.00
Expiration date of Notice of Commencement(the expiration date 2 is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
I .
Signed: . Date: o t 1111Z-0-2-1
Before me thi # t GN day of Sansio•e O°• in the County of Duval,State
Of Florida,has personally appeared D uv l t M.0 G
iceNNotary Public State d Florida Notary Public at Large,State of Florida,County of Duval.
M commission expires: O ' )13) V OZy
Sarah A,Callaway y p
My Commission GG 987948 Personally Known: / Pero',«itl it-no r•') or
14a00 Expires 08/13/2024 Produced Identification: