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1302 MAIN ST RES21-0221 -- 0=-0A ne_c-- Building Permit Application 0_...0N ( Updated 10/9/18 r City of Atlantic Beach Building Department (�(.{ �Q. **ALL INFORMATION �' ' 800 Seminole Road, Atlantic Beach, FL 32233 \ ` HIGHLIGHTED IN GRAY -Cflin9` IS REQUIRED. Phone: (904) 247-5826t� Email: Building-Dept@coab.us Job Address: `‘ '0 c)1 k 3 y v�0 ►A1.) Er Permit Number: g ES Z ( — 0 ZZ ( Legal Description S€C H- Lc4-14- ilk 224- RE# ) 7 i D 62--OO 4 b Valuation of Work(Replacement Cost)$ 9750 , Heated/Cooled SF Non-Heated/Cooled • Class of Work: ❑New ❑Addition ❑Alteration 'Repair ❑Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial tesidential • If an existing structure,is a fire sprinkler system installed?: ❑Yes 'fj?No • Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permi ) ❑N Describe in detail the type of work to be performed: \kyQu KTo-Ai (^./4� £$ S11 N�, 5\Ui1v6 (i '\`) b NI uYL SuD►u Florida Product Approval# f 3 9c.br?' ) for multiple products use product approval form Property Owner Information Name 04ilIRj,i5 - -vA'NS Address (9415- Ct?315C r City W.YSTb k4 Z,I4Th State Fi- Zip -3.).(v6-6 Phone 9a9,- 17C-' (7'$ L E-Mail QzVckhcCkt=Ck PC )i4kcc. (Olh Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information r Name of Company 611.--1-0V, V I)\)Y l- C ualifying Agent r/� Address i� C .PC' 5 2-2-CCityC>kAt56C- State —1- Zip j 2.0 65- Office Phone C1 t It-276 --6)c/ C 5 Job Site Contact Number State Certification/Registration# C'r3C_ '1.2-67,,1.2-67,,c i3 iv E-Mail Architect Name& Phone# Engineer's Name&Phone# Workers Compensation Insurer I(c.t.L. W)4IrE+A55ri, OR Exempt❑ Expiration Date S 17-5 /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;B,EFORE RE • 'DING Y• R NOTICE OF COMMENCEMENT. , h W 111 t� l< .. 1 — (Signature of Owner or Agent) rr (Signature of Contr.• or) Si d and sworn to(or aff :-•)before me thisZvda of Signed and sworn to(or affirmed •efore me this day of fit cs gna o*Sfa f 7(Signature of N ary) Ylii4;,, kijlot INDLESPERGER .0.wV%r'04• ':r ss•••;.:": MY COMMISSION#GG 353178 [personally Known OR ,f,‘*:** moi mLL = f nallyi<nown OREW, (\ 1EXPIRES:Octob4r[ ]Produced Identification \ '',,FOFe,.?: L+ ndedThruNotaryPubcl. $tl3 +tlentification :or+nxtiwr•GG)003,Typeof Identification: \ ication: 'J`,'"1`"'' ) RI (,; -= Z NOTICE OF COMMENCEMENT State of FL ci I D/ - Tax Folio No. VT € 52 — © 0'- i County of 9.VA-2- To 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 yin this NOTICE OF COMMENCEMENT. Legal Description of property being improved:-=\ ' c`S 3'T' ) 7 -2.s — 2 ct Sec A-+"L Res i C B f flc iVifrat*: L + 4 1341,c 22.b Address of property being improved: 3 e 2 /13011 MA) 5t Potioxe, 33m-04_`cL.. General description of improvements: ) 511-12 t) )O t.1 DF \1 IJ'y'L S 1-1)1 fq G OV-k.. (S')6J 6 51`Dr1�1� Y ' ]� _f Owner: ert-AR).,A F=v� S Address: (0475 (6U0-�I r14%5`O�lEN/GIS)5) C/- Owner's interest in site of the improvement: PA/ DkP?'i TY Fee Simple Titleholder(if other than owner): Name: Contractor: GA:TO \)I M) (-- Address: (-7,3 1:'fAA l\) { RD, L(.1/F-)4Ni F 37t(/ Telephone No.: 9c4-545----51\ j 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: } '. TONI GINDLESPER �,-}� Expiration date of Notice of Commencement(the expiration date is one (1)year fro �e c: f g mitgidf� ca n +ate is IIJspecified): =�;�^�•;a: EXPIRES:Ortrncra 2023 _ ,,K P`;�'' Bonded Thru Notary ry Public Underwriters THIS SPACE FOR RECORDER'S USE ONLY OWNER Doc#2021227352,OR BK 19889 Page 1362, -igned: Date: C- Number Pages:1 lefore me this 3 , day of (2)"- inathe Count of Duval State Recorded 08/31/2021 11:12 AM, )f Florida,has personally appeare. laj5�o 5 �,t vel JODY PHILLIPS CLERK CIRCUIT COURT DUVAL Jotary Public at Large,Sta e of Flo a,Cou , ,Duv I. COUNTY Ay commission expires: � ' �i� RECORDING $10.00 'ersonally Known: c _ T i ` or 'roduced Identification: l