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444 AQUATIC DR RFNCE21-0050 Building Permit Application Updated 10/9/18 f,- 1> City of Atlantic Beach Building Department **ALL INFORMATION } 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY It!•)' IS REQUIRED. Lig (904) 247-5826 Email: Building-Dept@coab.us Job Address: L1 g 1-Jfi- q cit-F. Dr . Permit Number: r N e a I - OOS Legal Description ( Fe n C'- rer"'fh i -t)' 38=x{"— 11- 1 C RE# ��I'1 q — J I ?' Valuation of Work(Replacement Cost)$ 'S(ODD Heated/Cooled SF Non-Heated/Cooled • Class of Work: ❑New DAddition ❑Alteration ,Repair ❑Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial 'Residential • If an existing structure,is a fire sprinkler system installed?: NYes ❑No • Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) CG3No Describe in detail the type of work to be performed: (404: C Vuo0c9) Florida Product Approval# for multiple products use product approval form Property Owner Information Name t rC -C.,) NA(L`--e oT Address 4 ('1 aciLi "-1 City KL State C� Zip 3 '2-23 3 Phone (6(0,1 ) E-Mail `t'W car J3C���nnuil c��M Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company Qualifying Agent Address City State Zip Office Phone Job Site Contact Number State Certification/Registration# E-Mail Architect Name& Phone# Engineer's Name&Phone# Workers Compensation Insurer OR Exempt❑ 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 RECORDING �v�YOUR TICE OF COMMENCEMENT. � r% G (Signature of Owner or Agent) (Signature of Contr or) Signed and sworn to(or affir` ed)before me ,his /Z n"day of Signed and sworn to(or affirme efore me this day of mum �/ •t o , • ) �7W (Signature of Notary) "a{Pv" TO -INDLESPERGER .� MY COMMISSION#GG 353178 [ ]Personally Known OR EXPIRES:&MOM&Kn.l n.OR. [ ]Produced Identification '•'Forl);•Q` Bonded ThruNcta�y� �kld 'cation Type of Identification: - • • . •n: LA, Owner Builder Affidavit **ALL INFORMATION r HIGHLIGHTED IN i% Cityof Atlantic Beach Building Department GRAY IS REQUIRED. 800 Seminole Rd, Atlantic Beach, FL 32233 'j 'r Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: I. FLORIDA STATUTES;CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. . III. IRS WITHHOLDING;OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO$5,000 PENALTY UNDER FLORIDA STATUTE NO.455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY"CERTIFICATE OF COMPETENCY"OR THE FLORIDA"CONTRACTORS CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904- 247-5826 OR BUILDING-DEPT@COAB.US ) IF IN DOUBT. V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOV,C DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. Job Address: 2"/ 4'1 fici MC/die Di-LV-/t, / —es-T-3- Owner Name:7r eAC - i LC 1"c 6-re5c/ 'Phone Number: (9641) 2.33 Mailing Address: q(.0-1 iq" VC he cry✓''- City: fl4iQF.f( 8eza. State: Zip: g2'L-7i Notarized Signature of Owner - C s The foregoing instrument was acknowledged before me this 1) day of r`•1 , 2024, in the State of Florida, County of .r,i.✓6l - L Signature of Notary Public LA grAk. ' '44 [ ] Personally Known OR [ ] Produced Identification Type of Identification: ,..;, 7 :v� c,r TONI GINDLESPERGER +• :, MY COMMISSION#GG 353178 Updated 10/24/18 EXPIRES:October 6,2023 °.aF FSO,• Bonded Thru Notary Public Underwriters V-- \ REVOCABLE ENCROACHMENT AGREEMENT 'l` N City of Atlantic Beach **ALL INFORMATION r 800 Seminole Road,Atlantic Beach,FL 32233 HIGHLIGHTED IN GRAY IS REQUIRED. .`.i1yY REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the State of Florida, hereinafter referred to as "CITY" and -Tr p.c-ci pn-(t -d-e 5 ur , of Atlantic Beach, Florida, hereinafter referred to as"USER". WITNESSETH: That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon the property for the purpose as described in thethCity of Atlantic Beach. This work is generally described as ' -CVIG2 . Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to relocation or removal on thirty(30)days'notice by CITY to USER,said notice to USER shall be given by certified mail,return Lt LI . 1 receipt requested,to the following address (4,)kiWhC l7rl vc, 3 Z 2.33 . • In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter upon the above described easement or property of the CITY, the USER shall replace at the USER's sole expense, any and all material necessarily displaced during the action of maintaining, repairing, operating, replacing or adding to of the utilities and facilities of the CITY or franchise utility provider. • The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes, Land Development Code and all other land use and code requirements of the CITY, including City Code Section 19-7(h) which states "Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but must be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks." • The USER, prior to making any changes from the approved plans and/or method, must obtain written approval from the City of Atlantic Beach Public Works Department, for said change within 30 days after the day of completion. • This permit shall inure to the benefit of, and be binding upon, the USER and their respective successors and assigns. • USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or specifications, to include utilities locate requirements and use limitations/requirements of easements, public right-of-ways and other public land. USER further agrees that the CITY and its officers and employees shall be saved harmless by the USER from any of the work herein under the terms of this permit and that all of said liabilities are hereby assumed by the USER. /C4c ,.....2)--r---4,—n---, Date y/i2-/ 2 I Property Owner/Agent(signed in presence of Notary Public) STATE OF FLORIDA, COUNTY OF DUVAL jj��// The foregoing instrument was acknowledged this /1}."day of Apr 20 v1-1 , by I`T(GcW AA L. &re 5 pr ,who personally appeared before me and rinted_1.i e of Si.ner) ackn edged that\he/! - signed the i• rument voluntarily for the purpose expressed in it. IW [............._,4Yli!';;.;•4,„o TONT GINDLESPERGER p,` :* MY COMMISSION#GG 353118Department Approval: 11.11Signature of Notary Pu•lic,Stag Floridai :e- EXPIRES:October 6,2023 F F°; Bonded Thru Notary Public Underwriters [ ] Personally Known h [ ] Produced Identification (Type) , ) Scott Williams, Public Works Director H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18 ''' <r ` �" Fence Addendum Updated 1/14/2021 i k City of Atlantic Beach Building Department ,3 ' 800 Seminole Road, Atlantic Beach, FL 322334430" PERMIT # Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: I Date: Lf L P-q ua-f-i c Drive_ 41 q( �1 Property Type: Lot Type/ Features: 11 Residential ❑ One Street frontage (interior lot) ❑ Commercial ❑ More than one street frontage (corner lot, through lot, etc.) ❑ Swimming Pool Fence Material: Fence Height (select all that apply): <I Wood ❑ Four Foot(4ft) ❑ Chain Link LSix Foot (6ft) ❑ Vinyl ❑ Other ❑ Block/Stone (Plan details required for footings and/or retaining walls) ❑ Other Fence Location: Please submit an accurate and current boundary survey showing all existing improvements(including building footprint, driveway, swimming pool, etc.) and location of fence/wall and any gates. Plan details required for block wall footings and/or retaining walls and any portion or fencing above 6ft in height. Will the fence be built in an easement? L❑ Yes (must submit separate Revocable Encroachment Agreement) ❑ No Will tree(s) be removed in association with proposed project? ❑ Yes (must submit separate Tree Removal Permit) XI No — -- Conditions of Approval: • Roll off container company must be on City approved list. Roil off container cannot be placed on City right-of-way. • All old fencing and debris must be removed from job site by contractor or homeowner. 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 RECORDING YOUR NOTICE OF COMMENCEMENT. BOUNDARY SURVEY .. .. . 'I- 1 ... . 0 . . • . . \ - • • •, .,• „. • , . 1 , .• -6 . 1 ;i 1Q- c, : .! I •* ' ..:' -i . ., . 1_OI' A .. .. . .• • , . .. 1-.• ; .: • • -.=. 0' !•\ SET 1/2" .435o, n100.0 \ tt • •‘r IRON ROD . . .... •:: . LB#7893 7.5 U.E•ID•E• _ ..- ._..... . . SB2 N,..0ALILINDDisPK . . , • -• , • tri ..—.., t\I 0.0' 31.9, ...,..___._ k.q_. -----•-•-• --- - 11 ,. . . . . -1 .: z- .::. . ....:•• 1 >. - ' , _ - 42.1' , . ",P. . ., • .- .< ,Z.; --.. t .:• ..' ... .* . m n _...., 0 . LOT 6-D ,4.0.x.p.. ......C°0NR7E vE :. ":42,c52',..i..lit ...........:.1.:...:.-..:',.. 1 U:....4 ....... . BUILDING ' • --" #444 4.0 - • . • . i- ----4-P- 1 'cl. .c. I-4 1 ' , ,., 25.0'- • ". . . cn (.71 0 ' NC FOUND la ' i .• . ' . 0 34.1'PARTsivotil . • . . /RON PIPE ' ''• , , 03 •Of 2043.58"W 100,°°' . , • \, 0.o, Sa NEIGHBOR'S . • . . , . . . . '. . • , .....IRON ROO BUIL , . • 11.8#7893 oN PRO • • .- pEILRDryINGLINISE ...- ' i• . , LOT 6-C , ... . .F. .,....1 SURI.:E'r NOTES CONCR It IiiigvE CROSSING NC f HE PROPERTY L?A:Z....,ON EASTERLY SIDE(:)c LOT. pRoPERTY SUPPLIED BY CITY N4 TER ANI?SEWER . • '1 ci. .....,,, 4' a No.8415 f'1... SURVEYORS CERT.'S CATE ..•0'....--TAII. GET ... ,..,. ... ,HEREBY CERTIFY THAT THIS BOUNDARY SURVEY .„ .; IS A TRUE AND CORRECT REPRESENTATION OF A SURVEYING LLC 0. :.• •- N, SURVEY PREPARED tODER MY DIRECTION. • 7 .,.. ; NOT VALID 1M TTIOUT AN AUTHENTICATE°ELECTRONIC IL STATE OF * SIGNATURE AND AUTHENTICATED ELECTRONIC SEAL LB#7893INNI.1.-....--- OR A RAISED EMBOSSED SEN.AND SIGNATURE o•J R, TIP...o° SERVING FLORIDA ,,t - •-2:-'6,/, /./..r.c,Lf4._ Kenneth J.Digitally signed by Kenneth J.Osborne 6250 N.MILITARY TRAIL,SUITE 102 WEST PALM BEACH.FL 33407 (SIGNED).--- ---. - - -- OsborneDate:2017.11.27 16:57:73-05'00' STATPriCtiE (561 640-4800 EWIDE PliONE (800)226.4807 KENNETH J OSBORNE ,,,41.4iI9kAgeN9f4;, STATEWIDE FACSIIWLE(800)741-0576 PROFESSIONAL SURVEYOR ANO MAPPER MAPS WEBSITE: httAlltargetsurveying.net LEGAL DESCRIPTION AND CERTIFICATION • Lot 6-D,AQUATIC GARDENS according to the Plat(hereof recorded in Plat Book 38,Pages 71 AND 71A.of the CURRENT Public Records of DUVAL County,Florida. • Community Number 120077 Panel:12031C0408 Suffix:H Flood Zone:X./AE Field Work 11/27/2017 • • • Certified To: TRACY GARFINKEL;AMERICA'S CHOICE TITLE COMPANY;CHICAGO TITLE INSURANCE COMPANY,LOAN DEPOT.COM LLC,its successors and/or assigns. Property Address. 444 AQUATIC DRIVE ATLANTIC BEACH,FL 32233 • • • Survey Number.309098 • • • • • • • • • • • ABBREVIATION DESCRJ TION: • Al. • • ANCHOR EASEMENT F.F.EL. FINISH FLOOR ELEVATION ORB, OFFICIAL RECORDS BOOK SYMBOL DESCRIPTIONS; NC NR CONDITIONER F.I.P. FOUND IRON PIPE (P) PLAT S.,M. BENCH MARK F.I.R. FOUND IRON ROD P.B. PLAT BOOK BR BEARING REFERENCE F.P.K. FOUND PARKER-KALON NAIL P.C. POINT OF CURVATURE (TIT •CATCH BASIN a MISC.FENCE ' (C) CALCULATED (L) LENGTH P.C.C. POINT OF COMPOUND CURVE (j *CENTERLINE ROAD 0 .PROPERTY CORNER • d CENTRAL 1 DELTA ANGLE I e c LIMITED ACCESS EASEMENT P.O.B. POINT OF BEGINNING CH CHORD L.M.E. LAKE MAINTENANCE EASEMENT P.O.C. POINT OF COMT NCEMENT °COVERED AREA �8 ,UTILITY BOX ID) DEED 1 DESCRIPTION P.R.C. POINT OF REVERSE CURVE P ' D.E. DRAINAGE EASEMENT M.P. MEASURED/FIELD VERIFIED A.'CP(•EXISTING ELEVATION °UTILITY POLE • M. MANHOLE P.T. POINT OF TANGENCY D.H. DRILL HOLE NW NAIL&DO.; kW RIGHT-OF-WAY ' WATER METER DAN DRIVEWAY HYDRANT �" , N.R. NOT RADLAI (R) RADWL I RADIUS © .MANHOLE ' E.O.W. EDGE OF WATER N.T.S. NOT TO SCALE S.I.R. SET IRON ROD ■WELL F.C.M. FOLIO CONCRETE MONUMENT O.N.L. OVERHEAD UTLITY LINES T.0.8. TOP OF BANK =METAL FENCE U.E. UTILITY EASEMENT °WOCD FENCE • PAGE 1 OF 2 PAGES tam*c0M%.Frri wflRow PACT 21 G11.. G ET ENERAL NOTES: LEGAL DESCRIPTION RROVDED BY 21 THE LANDS SHOWN HEREON WERE NOTERS ABSTRACTED FOR EASEMENTS OR OTHER RECORDED ENCUMBRANCES NOT SHOWN ON THE PLAT, aj 4� 3) UNDERGROUND PORTIONS OF FOOTINGS,FOUNDATIONS OR OTHER IMPROVEMENTS S V� i JNGLLC , • WERE NCI LOCATED. 4) WALL TIES ARE TO THE FACE OF THE WALL AND ARE NOT TO BE USED TO RECONSTRUCT BOUNDARY LINES. ...--- LB#7893 , 51 ONLY"01-SIBLE ENCROACHMENTS D. 61 DIMENSIONS SHOWN ARE PLAT AND MEASURED UNLESS OTHERWISE SHOWN. 7} FENCE OWNERSHIP NOT DETERMINED. SERVING FLORIDA 8) ELEVATIONS INDICATED HEREON ARE IN FEET AND DECIMALS REFERENCED TO N G.V.D.1929 6250 N,MILITARY TRAIL,SUITE 102 9) IN SOME INSTANCES,GRAPHIC REPRESENTATIONS HAVE BEEN EXAGGERATED TO MORE WEST PALM REACH.FL 3.3407 CLEARLY xLUSTRATE RELATIONSHIPS BETWEEN PHYSICAL IMPROVEMENTS AND/OR LOT LINES. PHONE (561)6404.800 IN ALL CASES,DIMENSIONS SHALL CONTROL THE LOCATION OF THE IMPROVEMENTS OVER STATEWIDE PHONE (800)2264607 SCALED POSITIONS. STATEWIDE FACSIMILE (800)T41.0576 WEBSITE: ntlp:rrproatsurveyUg.ne; Doc # 20172.464817 OR BK 18165 Page 1833, Number Pages : 1 , Recorded 10/27/2017 04 :34 PM, RONNIE FUIISELL CLERK CIRCUIT COURT DtrOiL COUNTY RECORDING .446.00 • Department of Hea1th•�Soeof Vital Statistics . :: STATE OF FLORIDA (STATEPILEr�tUCu�s� MARRIAGE RECORD • .Tray nvue� ; . ..... USE BLACK INK .:..... .._.:... ..............._. Thilfc fWiAot valid unless seat of Clark, ... Grail or County Court,appears thereon " '......••••. • -. • 2017 ML 3341230 APPLICATION NUMBER _ - _.. APPLICATION TO MARRY I. NAME OF SPOUSE(Fi!st,Mlddte,Lest) • 1b,MAIDEN SURNAME(dapplicabfe) 2.DATE OF BIRTH(Month,Day,Veer) KYLE TODD MCGREGOR 12/0611983 3a.RESIDENCE-CITY,TOWN,OR LOCATION 3b.COUNTY 3o:STATE 4.BIRTHPLACE(State or Foreign country NEPTUNE BEACH DUVAL t FLORIDA FLORIDA 5a NAME OF SPOUSE(Fust,Midtb'e,LaSC. . 6b..:71.EN SURNAME(I app+%nae) B.DATE OF BIRTH(Month,Day,Ye°t) TRACY MARIE GARFINKEL GARFINKEL 03/17/1983 7a. RESIDENCE-CITY,TOWN,OR LOCATION lb.COUNTY 7t.STATE 8.BIRTHPLACE(Stele or ForeIgn Country) JACKSONVILLE BEACH DUVAL .F.I:.E}R A_.: OHIO . ' H •-• . nSa. , •...e- a.. ••`i4 -• •,-HERSELF.STATE THAT HEI _• " TION;-'d•'0. . ON THS RECORD IS CORRECT TO THE BEST OF OUR IWOWLEDGE AND BEUEF;THAT NO LEGAL OBJECTION •THERARRIAGE NOR THE issuANCE CFA UCENSE TO AUTHORIZE THE SAME IS KNOWN TO US AND HEREBY APPLY FOR MENEST°MARRY.. 9.SIGNATU• OF VOL; E piN us&q tock kW 1O.SUBSCRIBED AND SWORN TO BEFORE ME ON(DATE) p_.+C:�t�6: iii y 10/02/2017 3' 1 It 11.TITLE O OFFICU4L ) 12 SIGNATU', s ICTAL Wad(ttLN • - i. i DEPUTY CLERK ' / i ?444 a r 13. SOWLTUREOFSPOUSE(stahemuneuainpDleckSM� -14. S`UBSORI9E•.• •fWORNTOBEFORE ME©NtD TE) _ - 15_TITLEOEOFF r<LI, " IS.SIGMA' • • OF ICIAL(u teck4W.... ' DEPUTYCLERK > /� •• LICENSE TO RRY - MA - AUTHORIZATION AND LICENSE ISHEREBYmatt TO ANY PERSON DULY AUTHORIZEOBYTIEtA OFTHE SfAk-T .OF FLORIDA TO PERFORM • A MARRIAGE CEREMONY WTTHIN THE STATE OF FLORIDA AND TO SOLEI.NAZETHE MARRIAGE OF THE.ABOVE NAMED PERSONS,THiISUCENSE MUST BE USED OR CRAFTER THE EFFECTNE DATE AND ON OR BEFORE THE EXPIRATION DATE IN THE STATE OF FLORIDA IN ORDER TO BE RECORDED AND VALID. o� ,t§ 17.COUNTY ISSUING LICENSE __ 1t.DATE IJCENSE ISSUED lea,DATE LICENSE EFFECTIVE 19.EXPI I DATE `� ......,....„,.4),',,. '" "" ``' 10/02/2017 , 1010512017 11.104/20A7 ,L� .40 ,•at°-#.`to DUVAL j..0".40 t r i % 1►e . 20a.SIGNATURE OF COURT CLERK OR JUDGE RONNIE FUSSELL 2011 TITLE +p,C. ', „,-.•.4;r X _ - CLERK OF CIRCUIT COURT IcJ >SY ,. 111.. CERTIFICATE OF MARRIAGE ' ,1 . ............ ........ 1111 1111.. I HEREBY CERTIFY THAI THE A I HEREBY CERTIFY THAT THE AsovERAWORFORIESINEREJOINEDBYMEINMARRIAGEINACCORDANCEWITHTHELAWSOFTHESTATEOF'FLORIDA. ,4,}:.• e . Lsiwr IAGEa,Day,Year) CII.ClT'<',I� LOCATION OF MARRIAGE lir dMri,sek-- �' _ LV •TUREOFPE, • • RFO•MINGarI-C: •NY(us*optio ••-ESS(Of pen. p. . ) P nit ,�.. . — -1111.. .."c :_ '`- "_`� MONY... 24 SIGNATURE OF WITNESS TO CEREMON .• -('��� P. .._ : y E � ,. - • • :. ; # 157801 $'i ;° �' SIGNATURE OFY1T#EBS TO CEiSMDtYfvbtaaktnq •-a r +� ei,aF. 8,20aao110 :. M .., 7. n,• „-- `'0.11AL ORrUSEBYt) I. ' .1..'%,2,-.:t, t. I.a r ; . N(OTITV: te�it:. :� ‘1.!:u.:.-..,Wel-t, `?�-.7,4."'• '' aj, �.:1:1.11:..: ..........4K;:..... ...._...........__.........._................_._................_............................_................_................. , • Y.;. .............................:1:11:.1..:'... _......••'.:,...;,i‘.........::._... : ..... _1111. . h