89 DEWEES AVE ROOF21-0004 Building Permit Application Updated 10/9/18
City of Atlantic Beach Building Department **ALL INFORMATION
:_ , 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: °C1 D�j t 1 f S s Permit Number: RO0FZ ( -Do o
Legal Description if.s-620`x-2s'-.��t>t./Y ^ 1�!/ ro'c r/voelAy.Loiortet7RE# /4756j-6.19400
Valuation of Work(Replacement Cost)$ , — Heated/Cooled SF Non-Heated/Cooled
• 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 proiect? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to b performed:
F(r�+-1)r��;� PVC-(W 0 sht6441-1- o U l� '` -5/0/7e-
q-/145-11;11
Florida Product Approval# a5 33, !� s-(P for multiple products use product approval form
Property Owner Information
Name P1AVivoiAl L. tinb , iJ Address �1
City 4r'f� `L OcgcX State F( Zip all-.33 Phone 90/ .316-ARO 3
E-Mail
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information �� "
Name of Company 4-5110/1-(--- /-1.00F4/i Qualifying Agent 7/f6197► /--
Address 9j a4�,i4✓t. ,So t'L City ,„7111:-A (3- f
,1 State =( Zip7) 5
Office Phone 5CJj""11 Job Site Contact Number 0 *-".
State Certification/Registration# C . Oc 46(( E-Mail 74 "bye ' 4 ,' r
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt❑ 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 OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
+ i nat re of Owner oT7lgent�� (Signature of Contractor)
Signed and sworn to(or affirmed)before me this 11 day of ned and sworn to(or a ed) •efore e this�7day of
�( ,b LAall n JioQ
anr>� .ft, A ,-20i (,b. 1.1;__ A d _
(Signature of Notary) —INIV r?ffi,17•a
iri�IrrlMi
DANIELLE WILLIS I
ersonall Known OR NotaryPublic-StateofFlorida
y Personally Known OR fTMYCOMSii175
• Commission#GG 080201p
.;'4-01,1 MyComm.E:x Expires [ (Produced Identification
Type of Identification: ( °.`.R.••' Bonded through National NotaryAssn. T'e of Identification: -l_����:° EXPIRES: lctober6 21
•n.ed Thru Notary Public Underwriters
NOTICE OF COMMENCEMENT
State of r10r I Tax Folio No.
County of T)uVa(
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: (5- O S °it. Ittbeigii6.10 vt 0.4:f/AU:SO P7 7/17B/ifrY
APC 44-01A-c_ hua
Address of property being improved: ' ( (JC,c✓e(-s l9-at c 3 211,7
General description of improvements: dx-IZfc/C
Owner: 1-71 P12ykNN Cu ant Address: 6) LACS Aft, h t/3euoi h Fiy2
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor:._5I)OfC jock. I�}�✓ ,0
Address: Q.Z 1 faZA.Avt. �'L U"�&dicA f ' 3). lf"
Telephone No.:cloy-3 ( -kV- 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 �;o : I
specified): _o,I_II nr�
THIS SPACE FOR RECORDER'S USE ONLY OWNER • ""
F• o
Date: ,1,� a( 1 0 3
Signed: It
Doc#2021020516,OR BK 19553 Page 1243, Before (th'. ,V 1 h da • • e-,up in the Coun y of Duval,St‘t, 3 3_ z
Number Pages:1 I w o F r^
Df Flori.a ..s pe sonally:ppeared , =a =
Recorded 01/25/2021 10:07 AM N ,
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL My comPmission expiresublic at Large, :
Florida,Countyof 4 a '
�1x
COUNTY
RECORDING $10.00 Personally Known: 1 ;be8 o
Produced Identification: + s