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1805 ATLANTIC BEACH DR RES20-0088 tirJr, City of Atlantic Beach APPLICATION NUMBER c, Building Department (To be assigned by the Building Department.) : 800 Seminole Road VG J C'a F � v,()O �.� Atlantic Beach, Florida 32233-5445 v Phone(904)247-5826 • Fax(904)247-5845 J� I c E-mail: building-dept@coab.us Date routed: / -vd-() City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: Bos l4 nfi c_ (3QttL l Ui . 13- •r. t review required Yes No 11 Building Applicant: Ph, ,`t(NS cU (S. Planning &Zoning ,, • Tree Administrator Project: 4 Iki sQ butt ioO f t.J t -t`la(]Sbi'j Public Works W `R j0,J a a(� d Public Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept.of Environmental Protection Florida Dept.of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: I 'Approved. [Denied. ❑Not applicable (Circle one.) Comments: BUILDING Robb, e 7 sc- ?qq3- PLANNING &ZONING viewed by: Date: 9— 4/"d0 TRF as revised. ❑Denied. ['Not applicable PURL r,�-°J�r D PUBLIC v LAD u I l PUBLIC "' ' awed by: Date: FIRES revised. I Denied. Not applicable Ci3VPk. 1(\e_feci ed by: Date: C\ C n- U Revised 05/1912( 1 , f Building Permit Application Updated 10/9/18 • ... City of Atlantic Beach Building Department **ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY is v%" IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us c G Job Address: /60S- 4r7,K..,45•4e44+7r{ Permit Number: -&S& O co0 Legal Description,4'J ?, /07Zo ii7C.67.61ex,' Git.lB dd/T Z RE# Valuation of Work(Replacement Cost)$ 20,000 Heated/Cooled SF Non-Heated/Cooled • Class of Work: ❑New ❑Addition ErAlteration ❑Repair ❑Move ❑Demo [Wool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercialtesidential 020 • If an existing structure,is a fire sprinkler system installed?: ❑Yes EiNo • Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) QNo Describe in detail the type of work to be performed:I - /C+'/ '•.: c f4 k-) e—X'►e r,s;ct'r3,.. 1EK;�'.C�ri 1'T`'> it >�!/7ez- Cl.7Os-a-oer'-c;so iiu,4t /LPccJ 4.-Q.10.+-1907 Florida Product Approval# for multiple products use product approval form Property Owner Information' Name irtilic.y/,�s7� i />JY©c/C99 Address //CZZS-/¢>VVGr,4fC • cerc/f, ,d/*/". _ City `/,IfyG , ciC.',7 State �aG Zip 32Z33' Phone Gx 2ate--&/2 E-Mail fJ:///rszt,tkt-,ee9/7icciS/i.ve- Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company 'F'tos11.P3 L so L-RS Qualifying Agent Address t'j Z C7GCPN 3lv 3223.:3 City A. State I Zip '3 22-3.� Office Phone 9O1{ -2.19 `1 Job Site Contact Number State Certification/Registration# (.:3C U?57.3 i N E-Mail p1Vj 11 i'P5 Bk.}i I i)L PS 6 Coles Asn- 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 ATTORNE'" FORE RECORDING YOUR NOTICE I F COMMENCEMENT.. Abilat (Signature of Owner or Agent) (Signature of Contr.ctor) Si d and sworn to(or affirmed) before me this/1 day of Signed and sworn to(or affirmed)before me this day of by lc/,c4' T ; . _'� � , se , .� ', - �La. nature .•Notary) 1 NotaryPublicig otary ol,prv,jLARRYWAl�flB Y) 1 , 1)��•J.> State. t,t'ota Public-State of Florida ' Commission#GG 22611 ilii G CommissionAGG140597 oKF`5' my Comm.Expires Jun 7,2022 [ ]P- ona •iwn dgComm.Expires Sep 4,2021 [ ] Bonded thr h National Notary Assn, [ Pr,,,, • roduced Identification„... yam/ Type of Identification: , Ac— 4-41-5" Type of Identification: 4�1� NOTICE OF COMMENCEMENT State of A-241-/0/1 Tax Folio No. County of 4e1744. 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. J� Legal Description of property being improved: • 4e2 'i .-v . , ` �, !/ - ice ,/ r� �� 1 /of,rrer=' /�!/rY4�/: r `' l y2 Y�fiA�/�!3� - / 4�"c "�.✓.eaU 0/47�lt/oei r_d o $sm� N��j 6� '%�1�SOS /.SQ��.Syy- (pr 7-j 2 �6-•25—29 E•�`(a Address of property being improved: /Weir l�f iA/ L' c�I ", 4- ,iac4 Az 3e?z. L� General description of improvements: /mp« corccs/> Air*dettisCS'G/ r„r,Q( e reAP ' /2e-ti.) ("trv�racrd�dr Cs--Are •4S -�X/JG:J piast '7 f 1(f,,��II Owner: ) j i -77,Gci,, � C," Address: /S0,-1f1 r/� ,�r rci Sr- lY x' ft- Owner's interest in site of the improvement: /OD Fee Simple Titleholder(if other than owner): Name: Contractor: /° 719ar'dC.-/demo MAR 2 0 2020 �9./ Address: 912 '/ Telephone No.:(917 C) 3,19-2 9 .)9 Fax No: Surety(if any) Address: Amount of Bond$ Telephone No: Fax No: Name and address of any person making a loan for the construction of the improvements Name: /v/4 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: Ay- /4,5 Address: /7// sit Qcr !�JK� 4 ,& 6�t@,e� fG .50233 Telephone No: 0.0&2f-i"9,17 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: S'4,,-4-4 I i 11-71-e, — Address: /19405-/ 1 1�:4Cedo� /4%'I ,6 iii ?2 3 Telephone No: 6,317 - 2.C49-4K9,0 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 c� Doc#2020065695,OR BK 19147 Page 688, Signe ,,,..,- aF. Number Pages:1 Before me this / µyP, # ��9d�$ WALTER y �. '01=� ��J� S in th ,County of Duval,State Recorded 03/20/2020 11:07 AM, Of Florida,has persorafl aryPublic- tate of Florida + e d RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL I !i'. - ristno 140 1Notary Public at Largb .-F dridni� mPi s q, 021 COUNTY My commission expir' • RECORDING $10.00 --Personally Known: or Produced Identification: i.,�