1938 Mary St RERF21-0027 App Building Permit Application Updated 10/9/18
:er,y City of Atlantic Beach Building Department **ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED.
Job Address: /73i. - /7 .0 7'7h1/0" S% Permit Number:
Legal Description 2y-9'2 /7 Yi -�fL �,✓_rs s-det �z5'r✓ /ZIT pk/c y RE# /7237i/ -0000
coo D
Valuation of Work(Replacement Cost)$ �-C Heated/Cooled SF S Non-Heated/Cooled
• Class of Work: DNew DAddition DAlteration DRepair DMove ODemo ❑Pool DWindow/Door
• Use of existing/proposed structure(s): OCommercial V2114esidential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes LtINo
• Will tree(sl be removed in association with proposed oroiect?DYes(must submit seoaraig Tree RemovvJ Permit) ❑No
Describe in detail the type of work to be performed: /?_/'-)ve /li✓.?,1 7z.r5PAec%5-- sib,✓ E ��
Florida Product Approval# /L /2' 3 3- /2e',% for multiple products use product approval form
Property Owner Information rit?ittJ
Name Cr9ziD,zi-i✓/._ /y/•9ic/� OK GHHI'v Address /�-3 3-3 f1/6 kG{L f iii t7 �/L
City 7,54X / State /L- Zip _72.22S— Phone f/C 5' 'SOY
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company C rel/Z. e 06-)fr---;1;116 Qualifying Agent
Address Y.. -a_3 A//7`TE/k 7/ 1 /Jr n/ City 7/)-X State fL Zip 3�--3='L)
Office Phone c7('''/' —/7X2V& Job Site Contact Number X --5-`/7 - S7Y--Z—
State Certification/Registration# CCC/ ,2-530 E-Mail Gr .".-/'1 C>O J 6-Zs" ,,,c c4-11
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer OR Exempt Er'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
RECORDINGYOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Ac_.nt) (Signature of Contractor)
Signed and sworn to(or affirmed)beforea this day of Signed and sworn to(or affirmed)before me his ' ay of
U!7 07/ ,by L., e/ Z "M4 NA/ 701,4,4; , 2-a2 by-dfrial") /APP27051A7IFil•PrAV
(Signature of Notary) (Signator of Notary)
VVV :'i�"'�`., MIC�iAEL K.GURR
Pers,onalt Known O' ( ersonally Known OR ;f fir, Notary Public State of Florida
y JUDITH SCA GG2972 Produced Identification
[ ]Produced Identifica �• MY COMMISSION#GG2972%I [ ] =�, fig`' Commission M HH 009715
Type of Identification: VW EXPIRES Jarmacy�L 707-1 Type of Identification: -..,ocr My Comm.Expires Jun 26,2024
Bonded through National Notary Assn.
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Doc # 2021026246, OR BK 19563 Page 508, Number Pages : 1,
Recorded 01/29/2021 09:53 AM, JODY PHILLIPS CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
•
•
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. J
Legal DescriptiQ4 of property being improved: 40 T 2 (DLv V
- 736 / 25'. -9'02 /7 42f $ % f .>t1+5 1,.�,scro��
Address of proPerty being improved: /73 7< / "é-'ST i977-9�r17 ,3022a3
General description of improvements: .Reil.)✓e -Sff-7>G
Owner.- l:::://e/KA S "77/94.1‘..) Address: //373 morale- k cifet i5 Z Pt/
Owner's interest In site of the improvement: /f0/17G oc✓ii/E/e— 7()C G4 3-222-f
- Fee Simple Titleholder(if other than owner)::
•
Name:
•
Contractor: CA✓rZ •
Address: 253 ' t�/�Tf S, /,1 ,&i2 & 7-ex
Telephone No.: 7DY-.S9/=S�7r� Fax No:
Surety(if any) . . •
Address: _ . Amount of.Bond$
Telephone No: Fax No: .
•
Name and address of any person making a loan forthe.construition 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 followingpersonto 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 JUDITH D.CALIFANO
MY'COMMISSION#06297281
Si ed: . ( ,41...;1'' EXPIRES:January 31.2202
Before me this .2/ day of.' ' �'�' l� in.the County of D I,State
Of Florida,has personally appeared .i./,,// 'A.14S 11144 -
Notary Public at Large,State of FlorJ ,County ofiQuval.
My commission expires: /l/ %� 20
Personally Known: ✓1 or
Produced Identification: •