830 Cavalla Rd App Building Permit Application Updated 10/9/18
=) City of Atlantic Beach Building Department **ALL INFORMATION
\ft.„.w..,
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
�--- IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: X36 (Ck-VCAL(CI_ gd1A 4-1"iC eaChii=L 3z733ermitNumber:
Legal Description Il-lb 17-i ' /? ?toFRoyu(Palrhsi/n,riMin/1-1K4,Z5 rt OFL 57.,x1�'1ut561Ky y �7z(RE# I 1 / 1 ( "0I6
Valuation of Work(Replacement Cost)$ 6, z/po Heated/Cooled SF /6'56 Non-Heated/Cooled (/8y
• Class of Work: ❑New ❑Addition ❑Alteration Repair ❑Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial PResidential
• If an existing structure, is a fire sprinkler system installed?: ❑Yes j&o
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed:)e-Uf ` St, o,/+-- 5h,'11/(,e 1 sI/p +1hLi c 4& (mty-+-
/ sq .�r>;5) 3/i�. P,- fch
Florida Product Approval# Pt--10 LLi RZo for multiple products use product approval form
Property OwnerInformation`
1 LA
.
Name rn� JP/LL Z- Address 7O/ U\I lizifW Cr Li
City --:i,ivis Pill!! State At- Zip e,l _Phone QG(/_ 237-7, 6
E-Mail Ary\V 5(.."4.-1-Z. V Ma.;I, LOVA
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company A • n I1n Qualifying Agent W, \. j
W i �� c .v O
t � hl(l
Address9 r7/ G(. 5-/- u_s i Inti P. City ,T(ALI< ilk, If State 7:t_ zip - 2 2 c7
Office Phone 9G- `1,(9- g /'7U Job Site Contact Number �^
State Certification/Registration# CGG 13 Z 9 5-2_/ E-Mail w Kahn e pv rl,J Y �(yrt (05, GVYI
Architect Name& Phone#
Engineer's Name& Phone#
Workers Compensation Insurer Gert n , 11-15(4641 6. com r OR Exempt o Expiration Date (ll ze
Application is hereby made to obtain a permit to do the work and instaations as indicated. I certify that no work br 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 a TTORNEY BEFORE
RECORDIrlIOUR,NOTICE OF COMMENCEMENT.
/t'1" O /
(Signature of Owner or Agent) (Signature of Contractor) g'
Sled and sworn to(or affirmed before me his day of Signed and sworn to(or affirmed) before me this b day of
rc/>nt.‘,,� __...)0:-.) I ,b Aril 4 i►�1r� L. C l"Cl7ruc��y, 2OZ I , by //Of/44 1?oA,j
%ijc" 4
.moi.
"IS':nature of Notary) (Si nature of No a
r. ,} ••:0'.,:.(%:-,. DON MICHAEL WATERS,JR.
BRUCE�� ' MY COMMISSION N GG 319490
! OMEN
t wico memoNa>e0fi."141.'•.:.
[ )Personally Known OR onally Known OR
(_. EXPIRE*Wintber7. ��,,E ��, = EXPIRES:A gust 3,2023
�'' r• •r .uced Identification :Jd.'.,.• BorMed Thru MWuy Public Underwifas
Produced Identification . : •i.,. _
?le of Identification: ( __ =Bonded The Wert Mc Identification: rSeNc//v� "'�"�'""iy`w
NOTICE OF COMMENCEMENT
(PREPARE INDUPLICATE) Ir,
Permit No. Tax Folio No ` 7 `7' I — `"1 7 �J zA V
State of -L. County of D i v rA l
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. r1
L gal description of propery, being improved: 6 r �� "� �� ,
O\Ic�i YO.A nS UV\ t Z a. s� o� 5T,7 \�k _ A s
Address of property being improved:�3 Q (JA-6--I(c. `LL �J l� I L 6 ` 2-131
General descnption of improvements: e y04-
Owner Ami L\r\ 17—
Address 7L0\r,)-L CT N(,..A. v t AL 3 4S 1 t
Owners interest in site of the improvement `5(If I _-
Fee Simple Titleholder Of other than owner)
Name
Addressn jT ` _ —
Contractor l )W 1k 1
Address 9 lrtStA v.)-tn�c l� l�So VI�lf �_ L 3LZ5 r
Phone No. 9t1 y'G/9 - !X)--1FaxNo. to L6 I 1�
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
ahone No. Fax No.
Name of person within the State of Florida,other than himself or herself,designated oy owner upon whom
notices or other documents may oe served:
Name
Address
Phone No. —Fax No.
In addition to himself or herself,owner designates the following person to receive a copy of the Lienors Notice as
provided in Section 713.06(2)(b),Florida Statutes.(Fill in at Owner's optic
.
Name A C 10,\J h tOoY't tr)(3
Address 5CA/ 1 e--
Phone
.Phone No. Fax No.
Expiration date of Notice of Commencement(tire expiration date is one(1)year from the date of recording unless a
oifferent date is specified):
THIS SPACE FOR RECORDER'S USE ONLY • /OWNER
Signed: , y I DATE r� _ "v1/
Betae me thb of ,. .,_ .. > _ • In e
County of Duva S Redd" has person I appeared
/���-"+y 1 CJ1 herein by
f. selp*rsa and atf'rrrs!`",at.?::Statements end dac'arat- 't herein
era true and accurate -
BRUCE J.O EN
14 MY co1Yt16S+1 i GG 335709
Aip -`i EXPIRES:September 7,2023
"s•.of Thni tbtary Public Umierwilae•
No at ' blic at Large.Stile of _ C
My commission expires. 7-7 � --- —
Personally Known
' Produced Idenallcation )t .3Z)C.-