31 N Forrestal Cir Siding Submittal -t '_ Building Permit Application Updated 10/9/18
Ji; ;•
City of Atlantic Beach Building Department **ALL INFORMATION
u
ill/ V 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
"''i yr IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address:3) FORRE57#1L C112-.N. An- Ftp 332.?3 Permit Number:
30-5b 39- ZS - 29 E
Legal Description/ dM-nt- BEALO Vit'-/t VNrr l , L OT t$ ED-K ) RE# I1/713- 0000
Valuation of Work(Replacement Cost)$ 3,500. Heated/Cooled SF /5g9 Non-Heated/Cooled 5Bg
• Class of Work: ❑New ❑Addition ❑Alteration kRepair [Move ❑Demo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial litesidential EC FIVE
• If an existing structure, is a fire sprinkler system installed?: ❑Yes tiCINo JUN 0 2 2021
• Will tree(s) be removed in association with proposed proiect? ❑Yes(must submit sepa a Tree Removal Permi 01 No
Describe in detail the type of work to be performed:
N.
RFT't-4-GE p-oTTE N WOOD ON S I D IN(- e 'fl i Y 1
Florida Product Approval# for multiple products use product approval form
0
� r+A Ffk/Fw- WUC1) 14114. 5141" 3)) Z c.t'T i2G U F 44vvW 30-3-k, 11P� L 1,i-n, �t'
Property Owner Inform I t �
Name WAMa-1) 4 F CA-17--(E7Z- Address 3) FO1aZF57 4-v Gm. N
City A-Ti.ANT)G 13ell-tA State Zip 322-33 Phone 5014 - &ail - Q00)
E-Mail b holt and 195 @aol . com
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company c.--‘5.) • Qualifying Agent C-72-M-)4- 6PE .1 t.J21
Address cOJ PENYF)IQAI 1 b City 41 yi ) G tJ1 State Zip 322-66
Office Phone ?Oy 753 /003 Job Site Contact Number 30 759 /003
State Certification/Registration# C.-(31.-/2_&(72-83 E-Mail RENOV/ 0/1/ yC-5) ..3 t'k a) 'conk
Architect Name& Phone#
Engineer's Name& Phone# k
Workers Compensation Insurer ADP OR Exempt❑ Expiration Date 2- Zl -2-2-
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 YOUR NOTICE OF COMMENCEMENT. cia..6 ...,......,_
(Signature of Owner or Agent) (Signature of Contractor)
Signed and sworn to(or affirmedl1iibefore me this /Si-day of Signed and sworn to(or affirmed) before me this 14,t-day of
Jtine- , 202/ , by //l a Y JV,. , 2024 , by Cc.*C),un�
ZSienare of NotaAyr — Si na ure otary)
SANDRA V. ANDERSON "��
;� �B ;s••�;, SANDRA V. ANDERSON
?° �� Notary Public State of Florida _:valMq Notary Public-State of Florida
_' � Personally Known OR ;y7 .-= Commission#GG 913925
Personally Known OR ;�;- ,o; Commission#GG 913925 ,
.awe, My Commission Expires [ ] Produced Identification ''',?!,.„';P` My Commission Expires
[ ]Produced Identificatio September 17,2023 September 17,2023
Type of Identification: Type of Identification: _
NOTICE OF COMMENCEMENT
State of ft-o/24 UA' Tax Folio No.
County of DOM.-
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: 3O -5(o 3 - Z-S - 25 E / 49-2-471 gt --4
1 t - 1 uN I'f 1 � 15 131-KI
n
Address of property being improved: 31 I'ORT EST GI lz N � 4-T -1364 32.2-53
General description of improvements: 12-v71-41.„5-- 72.0j'J-J VJ cot) on, S 1 t:AN r
Owner: VU #12-TIM- 66112-1-P2- Address: 31 FOfZT2E9T714- GTZ 1J 4'(7-13tH f+-37-2-33
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: ('ON 5r12-VMON S v cc , ' INND(/p-�ic5 it Mc-
Address:
NcAddress: 501 Pg-Afri ,?n/ 4/6rn/NE 219- ft, 322&&
Telephone No.: g01 759 003 Fax No:
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):
eGi±/ 1
�1� �
THIS SPACE FOR RECORDER'S USE ONLY OWNER �' �"L�Lr � t
Doc#2021139113,OR BK 19748 Page 737,
Signed: Date: 1) 2-021Number Pages:1
Recorded 06/02/2021 01:46 PM, Before me this IS+ day of J'iq WC.yy((2-024 in the County of Duval,State
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL Of Florida,has personally appeared ) ' a rf-k, ✓3i
COUNTY Notary Public at Large,State of
;�.�j,,,�,,, A
RECORDING $10.00 V. ANDERSON
My commission :
punlir-State of F10rida
Personally Kr. n: k • * Commission#GG 913925 or
My Commission Expires
• odu de,tification: September 17,2023