1767 W Park Ter Roof NOCDoc # 2021083152, OR BK 19658 Page 1223, Number Pages: 1,
Recorded 04/01/2021 09:19 AM, JODY PHILLIPS CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00 '
Permit No.
elate of FL
Yo whom fi may oon(*m:
aDL C61ag MA14c IW_z11 M M IT
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Ter, Folio
County at -
1119 mdsssigne'd hevaby €nfon7s you tttzi Improverften s will be oiade to certain rest property, and in
secoedmics vvit.'s saattan 7,13 of the Rork3_ .1;tarAes, the followinif ttiforrnstion is staiad in flits 00110E 6P
1:101M1h WI 122tfiMT. I
Legs! desoyiptton of property being irriproved: \
Improved: -L-11-n-) ____ Nv-A"
1 f f C3 0 r
Genarai doscriptlon of Improvements:
�nmats est m site of b '. iriprover xG
Fee Simple MU. -holder if eher than owner)
Narr.9 -- —
Address
Contractor MMP -NO BIU IMS MG-FINGWC
Address PO BOX 330337 ATLAWTlC Bt3ACH r 32233-- - � __
Phone iVo, 8042496899 _._ !•a't NO. 904 -?46-48 1() '••~,—.•-
Surety (fr any) --
Address i
�—^ amount of bond 5
Phone No. Fax No. -^
Name and address of any person making a loan or tate construedon of the im�rovernerha.
Name
AddressPhone No. No. --•--•---------
_ - Fen No.
Name of Parson within ate Atate of Fiogaa, o`. er _gar, hdnself, des:grated by otter upon whom notices or o117er
dowments may L)e served:
Name DANNYFDwANO
p ^ Andress 155 LEW T SUITE: a;'L,:_ql)-C 3GI Gli FL 322,33 -- --" `-
Phone No. 904-&10.0476 Fax No ----- P-'-
In addition to hhseif, owner designates the ioliv.,, ing pefs3n to r2cetvg 2 spy pp the lienors MOV06 as provided n
Fftl in at OwlteYs option).
Section 713.46 (2) {b), Florida Statutes. {
Name
Address
Phone No. Fax i 10
d tmnt date is _���
ogres or Nouse of ^entnlenca rlsnt {the
diff>rrat7t oxPkation data Is one (1) year torn the date of recording unless a
dsteed):
st-its sires= t=oto 2�co���.�� usr 00LY i ���,�; Q ' �
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sof F In the
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e end accurate tafemerds arrf deti`ara:bas aeretn
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