363 Atlantic Blvd Units 13 & 14 DEMO21-0003 App ` Building Permit Application :n�creat^qt.4
1. _.- City of Atlantic Beach Building Department ••ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 O/,A 4 0_, 1 /HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept@coab.us
II IS REQUIRED.
lob Address: 3 ta--S A 11,6.)-tic 6i-00 /'}--L-A,PT-re-cacti F-PermitrtNumber.
Lela!Description 5-r‘S2 I•-5 - 23E 1 j,4 AIL- �Br51 9r 11 rGlp P�19 REd I G9130 -eco 3 _
Re-cd. O/A, f2:2s0-5lo gt-g I
Valuation of Work(Replacement Cost)S '1CJO6,CIO Heated/Cooled SF Non-Heated/Cooled
• Class of Work: :New [11-Addition OAlteration i.ORepair 0Move 5IDemo TiPool Window/Door
• Use of existing/proposed structure(s): TiCommercial °Residential
• if an existing structure,is a fire sprinkler system installed?: ❑Yes ONo
• Will tree(S)¢e removed in association with proposed Aroiect?DYes(must submit separate Tree Removal Permit). .fJo
Describe in detail the type of work to be performedhr�r%: F,.,.i'SFIBS,vniv5?3.0iuAv-- SX.,-.1- c, ( i—>IrSr
Ca,;,-,1-.7k i $ q. Basta.-nit\ C.Ci LT.-)C
Florida Product Approval u _ for multiple products use product approval fort
Property Owner Information
LA—C. _Address 553. .i,21s! 43aP S i r
Name ttSfi;,'-(�C.. ___.
City G hX.,->Est'ILL'^ State FLZip 32 .53 Phone —
E-Mail roti 41. 16+e9 crop.cc."n
Owner or Agent(If Agent,Power of Attorney cr Agency Letter Required)
Contractor Information
�+ n
Name of Company CT:�OPO ELL._ &.: -eZctRS r.' %C i�Qualifying Agent YATR ic,(t S,,., ROAOL00"
Address 11221 t-+)Lc.- L-ANp. City 5T f3.,c t i-u-,4a._State Fr.,. Zip av12
Office PPhone '...)C 4-- it'i3- 5( Y? _ Job Site Contact Number "A",14-,3. 56'37
State Certification/Registration ft c4c,1151323 E-Mail hruaAb .Id e c','sc•t'y r•..:r:.1'
Architect Name&Phone a DeJ.•3-g.__1r- :LI-ri.*s :.)0`}-331 - 2.55Q
Engineer's Name& Phone rf
Workers Compensation insurer J.S1f'e {I- I -$. CatlIc OR Exempt::i Expiration Date /UJ f R.°21
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 LEND R OR A •'.I •RNEY BEFORE
RECORDING YOUR--NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor)
: if '
ned and sworn to(or affirmed}before me this ..21-*e.:ay of StAc.lt.it.1 s\/orn tc(orm )before e this-r^,__ av,-
1Lt
)10 1-/ '-' —•t
,icaf:r t Notavl
A-Personally Known OR .✓' onally Known Ot
Notary F„W,c Slate of FIor oe
i Produced identificatio +P Rebecca Jensen I Produced Ident(fica: �AYN •,, TONI GINDLESPERGER
Type of identification my Convrnsson GG]S3dt; Type of identification. ('r .T.,.'c s_ MY COMMISSION#GO 353178
„w xfxrsa or,i ?a '-.,:.;• �''" '.; EXPIRES:October 6,2023
'4i),';6•?:';':
:. p
i),';;?: Bonded Thru Notary Public Underwriters
NOTICE OF COMMENCEMENT
State of f LO s Q{i Tax Folio No. CtCC 5
County of D6.1 VAL-
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; %"C 9 21 -2,5` 2'-3 I I•4 L 's 7 `) ! I filth
P T ��T y w P A of t (,2 250~5 tO &,ti
7 1 1 113
Address of property being improved: Sim A T` 'tt" rc Or:0(110 `, 3 2-x-33 7 0 1)4
General description of improvements fKe 4?U L- �i C.E I G f c:GG,"V,r1r37 t= A f 01C H CiAF e `—�
Owner; N`'1Noka L_L C, Address: -45 3E, N.W. '4. '5iizaLr6Aipits :ill.E
Owner's interest in site of the improvement: CORE.-)
Fee Simple Titleholder(if other than owner): _
Name:
Contractor: B RORQ5 h:;:LO)iZ 1,AJc
Address: E Hr«I_ L.>,•--y f--yr f��c S��-&rL. 32G ,_
Telephone No: 9C4-F,i3 - 74 7 Fax No: pCl a9' 9520
Surety(if any)
Address: Amount of Bond S _
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:
_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
•
Signed: Date 31 L 2(
Before me this_a day of N in the cinquty a Stare
Of Florida.has personally appeared--TYQ.A.
Notary Public at Large,State of Flord. CoLinty of 8ereef. /AIACA.C.P.
My commission expires: 1! 20 . .
Personally known: _gyp y�y� *«ppr,ye
Produced Identification: Rebecca Jenseny
'? Aly Oomrruaaan GG 15JE51
�i4�� Eayws 07110,2023