2017 Duna Vista Garage Door Replacement Building Permit Application ,irldoted 10/9,'10
$ - City of Atlantic Beach Building Department ,.*u.INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
Phone: (904) 247-5826 Email: Building-DeptgOco4b.us
lob Addressi 2.01-7 VU4A Vt)itr (01/4- ) Permit Number
. ..... , _ .. ....
Legal Description 110" I 70 2:PS - )1E • 3114 41.111 Oil Two j•__ to/ (07 Rio I 015olo 7.1‘2-41
Valuation of Work(Replacement Cost) S 30 DOD Heated/Cooled SF Non- FacCall V
• Class of Work ONew ElAcklition LIAlterationepair . .Move 1-Demo P(x)1 : °0€132 0 2021
• Use of existing/proposed structure(s): LiCommercia I Xesidential
• If an existing structure,is a fire spnakler system installed): oyes )4N0 BY:
• A t .• I' f., CI . I #• R A E,h ,•.,. e o„gio,..411 S “T1 i .. i f 1/2. R, rn.i . $ !...,%•
Desalt*in detail the type of work to be performed
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Florida Product Aoptcva,# 17-/oLi 00 - for tru...“'“Pie pioaocts use p400410 Oi3prO`,,,:r iorm
troperty Owner InfOrIngiCOI
Name i i•J (A/01,FC L Address z.0 r) awn Vo•t4 C
City
1,i it7 et-• _Z 1p 'b!' ,..... phone ft 6 q zo, /z u
E-Mail LI OvN/v`i-u1A,S,---g ..hOte”illitc!bl..- ,-. r.....
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) 0 v•/^/45/t. '
f2Pitittglint9M.g101 .
Name of Company : -4- . by> ., Qualifying Agent / / ?4.
Actress 0 , irr,...^ ei, ',„ „ , ,_ City_thak3gua: e State 41 Zip
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- 'I Job Site Contact NumberO ,ayke.4
State Certification/Registration it E i Mail r(.6(jr:3)."5.- ° /( S '-1
Architect Name& Phone I
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Engineer's Name& Phone if„ (2c;:&e,.. '>7. -------
Workers Compensation insurer Oi Exempt tiroiration Date___________________
Application is hereby made to obtain a permit to do the work and installations as indicated I certify that no work or installation hai.,
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulating
cc nstruction m this jurisdiction I understand that a separate permit must be secured for ELECTRiCAL WORK, Pt UMBiNG,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 zgencies
OWNER'S AFFIDAVIT i 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 toning
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 ATTOItNEY BEFORE
RECORDING VIDOR NOTI E * C*IVIMENCEMENT. _. _ -
eai' ___.............., ,-......... _
NI (s,vatwe of Owner r ' emit) Oignator e of Contractor)afItti and sworn to(or affirmed)before me his _d iiy of Signed and sworn to(or affirmed)before Te thi 221jay of
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PERROI ,
-T-1 : • r•r • - FAY COMIAISSION t GG253947
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1.1 ItY CDIAMISSION SI GG 253947 :•. :
---.;--;,...^1-ig:: EXPIRES:September 10,2022
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ft_own OR .. .5.7... '--;-,. .1 EXPIRES:September 10,2022 ' 1 per 54,44140.t„own oR \ ?,':.' BonTh
ded ru Notary pow underaTitera 41
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Bonded Tixu Notary Pubk Underwriters
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Type of identification,_ ype uf identification,,,_.) 4_,/,/,E,IVerS ,_ j__C Pni- e-
NOTICE OF COMMENCEMENT
State of gcy'eticl Tax Folio No. /d1 5176 `/6.2 Y
County of OC/14.1 /
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: 4U-37 09-2's " ,2. i'j / SQ I(./c, ft/cs _7/rd
Address of property being improved: _2`0,,1 7 OCJ i (�.'rJ "-'�
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General description of improvements: A/•<lit... -049 e ciao-.'
Owner: J til? tAloi / / Address: .8/? ae/ct 0d fe-i L /-
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner): _
Name: ,s / yg _
Contractor: t^�'*Y1s�G 06(.3--j*" Cis nc'$e? 64,0,-3--
Address:Address:
Telephone No.: QV L'7)g V Q a 1 Fax No:
Surety(if any)
Address: 410‘ T4 be'— dr i--) Amount of Bond$
Telephone No: ‘10‘1%"7()-14-4610/ 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 toDoc#2021216731,OR BK 19872 Page 865, 1
713.06(2)(b),Florida Statues. (Fill in at Owner's option) Number Pages: 1
Name: Recorded 08/20/2021 11:19 AM,
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL
Address: COUNTY
RECORDING $10.00
Telephone No: Fax Nc
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
ki" IA- l g ',/t.
Signed: 4 -0aDate:
— Before me this r dayof in the C nt f Duval,State
►e�..IISAMANTHA PERRON �1_ ,
`�`'s Of Florida,has personally appeared �� h Q/{ �
'�+l: �, MY COMMISSION Notary Public at Large,State o Io ida,Co ty of Duva.
i °N. :: EXPIRES:September fa My commission expires: 7/4/ 6,t ,
L Banded Thu Notary Punk Underlain Y
Personal/ Known: or
/ro Produced Identification:
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