2215 Alicia Ln RES21-0048 Int Remodel, Remove FP 0In,'r-,r.,. RESIDENTIAL PERMIT PERMIT NUMBER
y ,#. : �\
"" S CITY OF ATLANTIC BEACH RES21-0048
,v v 800 SEMINOLE ROAD ISSUED: 2/23/2021
-4-9-iill. EXPIRES: 8/22/2021
ATLANTIC BEACH, FL 32233
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
2215 ALICIA LN RESIDENTIAL ALTERATION INTERIOR REMODEL- $72593.38
RESIDENTIAL REMOVING FIREPLACE
TYPE OF REAL ESTATE ; BUILDING USE SUBDIVISION:
CONSTRUCTION: i NUMBER: GROUP:
169519 0755 TIFFANY BY THE SEA
COMPANY: ADDRESS: CITY: I STATE: i ZIP:
BOSCO BUILDING 2158 MAYPORT RD ATLANTIC BEACH FL 32233
CONTRACTORS
OWNER: ADDRESS: i CITY: I STATE: ZIP:
LEWIS GARY L 2215 ALICIA LN ATLANTIC BEACH FL 32233
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT II`
YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 BUILDING IN-PROGRESS INSPECTION REQUIRED INFORMATIONAL
Notes:
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PERMIT 455-0000-322-1000 0 $372.00
BUILDING PLAN CHECK 455-0000-322-1001 0 $186.00
Issued Date:2/23/2021 1 of 2
1
rS"'`VLeyf, RESIDENTIAL PERMIT PERMIT NUMBER
,5 ' RES21-0048
.:• s, CITY OF ATLANTIC BEACH
�w 800 SEMINOLE ROAD ISSUED: 2/23/2021
'-° 9" ATLANTIC BEACH FL 32233 EXPIRES: 8/22/2021
i
STATE DBPR SURCHARGE 455-0000-208-0700 0 $8.37
STATE DCA SURCHARGE 455-0000-208-0600 0 $5.58
TOTAL:$571.95
Issued Date:2/23/2021 2 of 2
JOB COPY/. REVIEWED
/,SY�-,•` , Building Permit Application i="� By City of Atlantic Beach Building Department Mike Jones at 10:18 am, Feb 20, 2021
ii
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
--,$); .!..)›-7
IS REQUIRED.
Phone: (904) 247-5826 Email:
Building-Dept@coab.usuilding-Dept@coab.us
RES21-0048
Job Address: 01.2 15 lees/ LA)• QizL& N/14._ Permit Number:
/
Legal Description 4 - / 37.2..5 e29( iFWCit (4 tor
? RE# Ib9.0/9'07,5
i1 361 Heated 3
Cooled SF 36 Non-Heated/Cooled
Valuation of Work(Replacement Cost)$ w7 �,� /
• Class of Work: ONew ❑Addition giAlteration (=••Repair EMove (Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial C 2esidential
• If an existing structure,is a fire sprinkler system installed?: LiYes r, N//
O 11
• Will tree(s)be removed in association with proposed prosect? ❑Yes(must submit separate Tree RemovalfPermit) a-i o
Describe in detail the type of work to be performed: l� rJe 0 R�obte FCt.,,,,,t , (,'t'.�(n•r6 Q(J /bi , ,c1,
6 ‘ APAta AM Tot.S , eurd M/; corn) c 5(�, Re/'�o% MJ' KEPI 6tiouJe/ i i '
A fi g OP Ar , /l1h�, 6Ar,/5. . m")oV 'crei;'te rJ/9ihs 'S
Florida Product Approval# ,1,)4 _ for multiple products use product approval form
Property Owner Information
Name G/14) 4. 1I&r.5 Address Gall- >/tL i /d• o
City j iAt)i AC/ State /e- Zip .3 33 Phone Oil) (lug -1000
E-Mail G-AR'/ fC,q .51-nff.G2M
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)_
Contractor Information ,) /�
Name of Company SCG,, J ZI254 (thi erv/�c .. "C'•Qualifying Agent fQ00 J o —
Address 15g /11( p(1 1i o/f11 / City itakjtcz ser State Zip .3433
Office Phone • • ,. ! Job Site Contact Number seri
, 3T 5 LG,
State Certification Registration# :6 'aiSU,A0, E-mail t3C�'IO jo.Cvo3L GO/11
I
Architect Name&Phone# .Utt
Engineer's Name&Phone#_ 4. r
Workers Compensation Insurer . Eai) &/&'(, ' 5 OR Exempt n Expiration Date Of .' 3/
c iG GOilit3 G� o° I miO
Application is hereby made to obtain a permit o o tie 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 . NCIN ONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING ,�U •.' ICE OF COMMENCEMENT.
r _ •:YlgY,,4/:)("----="" ---
(Sig -ture of Owner or Agent) (Signature of Contractor)
�IV/s/c,fbl/ 1-9Re a++/
�dland sw c P/r'aae l' Si Signed and sworn to(or affirmed)before me this fr±day of
Signed and swo�to(or affirmed)before me this day of g
• ate 7-v i 1 ,by '4/1 y J,1 -S jxm{ - , 7-6A/ ,by 2-00/2 4 /metro
AAA: X,��_ r ttA1 ,°
(Signature of Notary1 (Siapature of Nntarvl
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s,all eDon ollQnd u�loN fuLa PePuo'a ;�o;so •, COZZ'8[� 1aC1 S3211dX3 '; i
549846 09#N01SSIriri00 AN •'
Personally Knoa (949846`)0#NOISSIHlri00 Ari = '*- ('1 Personally Known ORa.
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Type of Identificatl .___ Type of Identification: -
JOB COPY RES21-0048
NOTICE OF COMMENCEMENT
State of FI ORIDA Tax Folio No.
County of DUVAL
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: 74 -q7 37• - do - -(.row or 77-k-
COI q
Address of property being improved: /AIS ,Clef/ LA) . /r .JrrG £,1 4 IL -3,
General description of improvements: PMAIC LUQ ALL , d4 fY �! C' /6--/1bds- / �.a
✓ r>>;i5 I O �o4.. .414)efn.4' Ir ,€ ltr, i`� /5 I T/6. /,&!C I Zix‘,� &/flies
/i t cJ eE4r opery. ,111110t6' 4/q� 6-
Owner: /..4/A1 I 1Etk1.�5 Address: ; E' 4tr r,' L,(1 Qroor/_ 1.344-14
Owner's interest in site of the improvement: Ot-J4)a
Fee Simple Titleholder(if other than owner):
Name: ``"�
Contractor: 00660 6e-t 1.)G �
eolkaero ,L•ik
Address: 11'16) /11441r gruivrz . I;E-ne/l i 2 ,3 33
.
Telephone No.: 41/03Y/ ' Fax No: (qoij A0 -03034
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 date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER /r
Doc#2021025168,OR BK 19561 Page 995, Signed: / Date: I/,21;'/g-/
Number Pages 1 Before me this da
Recorded 01/28/2021 11:33 AM, day of . 'P ( in the County of Duval,State
Of Florida,has personally appeared
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL / l'y �-41P-5 �
COUNTY Notary Public at Large,Sta - • • •a Count of Duval.
RECORDING $10.00 My commission expires: y�
'PersonallyKnown £ZOL': ,� •: '_; Z:= or
Produced Identification: • , , ,� '_, I
3dOd,rive u 8,...••.if.