350 SEMINOLE RD RES21-0277 (---
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'i'J�''f, Building Permit Application Updated 10/9/18
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'l City of Atlantic Beach Building Department **ALL INFORMATION
/ 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
•.-,_. IS REQUIRED.
ccPhone: (904) 247-5826 Email: Building-Deept@coab.us
JobAddress3✓9 S&t1/ isd O(.e AD/Al -Akir 1 c v Permit Number: E .i - O G / 7
Legal Description/0--/.5-A-ZS"2 1 e 56-c- 2 .5'4 LTA i A G01 L6 s RE#/70 41 o -(x9.1.
Valuation of Work(Replacement Cost)$ S, b Z S 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 Nt2esidential
• If an existing structure, is a fire sprinkler system installed?: :Wes ❑No
• Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) ❑No
Describe in detail the type of work to be performed:
H(J G-LA- A 146-0 a S SCT e 2.1 o ✓L -1-4... 1/44 /2-t'pc../4 c E-pi/ E- h[ ?
t-+ Ar t - -T ,A it f1.-
Florida Product Approval# F L. 1 3 I % Z for multiple products use product approval form
Property Owner Information
Name fl4I G F9d (.. TO(}-t e 7 Address 335-0 ,16-/e/iso O L& a_ O
City i4TLp7A17i c P & 4-C-11 c---4.. State Ft... Zip 3 2 L 3 3 Phone `x'04. Z 5-4. e ' Z 6
E-Mail m K 8 2 2 E (a Lj/*$1/4-/'— . CA,n►
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
Name of Com any T H• A- 4 AA-44 / //'41 C-• Qualifying Agent /0/1/16 *V f-61"2 V47 N Ci c.
Address 147 Ho G-7 g c.43,TJo M i2 O City ST. o H ht S State TZ- Zip 3 2. LSry
Office Phone /r'04, 66 Z..7 7 27 Job Site Contact Number 90 4 . 6 6 2.. 77 37
State Certification/Registration# Az 1-f — 5\_ E-Mail 7-11#49 /ZOA/.I'/D/N y.8 ,41./7•c"0. Ci' .
Architect Name& Phone# 7 COL4Wry
Engineer's Name& Phone#
Workers Compensation Insurer ` x ErP7 "T OR ExemptX Expiration Date 1 2-/31/ 24r,Zi
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
RECORDI YOUR OT O OMMENCEMENT.
.---
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( ignature of Owner or At f.i . }!-.Contractor)
iiiii
Signed and sworn to(or affirmed),before me this", day of Signed and sworn to(or affirmed)before me this fC) day of
`\ i\01,! by_M\U �C 1),- .1.4,1 /4���'S � . 21•2/ , by vvkl fir/ ,o/ L
..,. i :Vir-
r. a y) 01741.7e o �-ry)
,A. : omission#GG 943250
`.';..s-•;o: Expires April 28.2024 t�aYP�a" VANESSA1.LOVETT
F °P' Bonded Thru Troy Fain Insurance 800.385-7019 :.; ,�-` :.: Commission#GG 292460
'" OF Ft,•
[ ] ersonally Known Oli+ [ ]Personally Known OR _�" '1'ii' i Expires
[ '"T• -••T p January 17,2023
roduced Identification Produced Identificatio •:FoFF�oP,
(� ` / Bonded Thr;Troy Fain insurance 800-385
Type of Identification:V\. `3�,\ � `"1 -. \ Type of Identification: L�� _
NOTICE OF COMMENCEMENT
State of Tax Folio No. I 70 4 ;0 - V 000
County of DUI/A L.
ToWhom 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: /0 — /5 /6 — 2. S— 2 -75
SC- c 2 S46-7/1- 112, 60T 2 6S'
Address of property being improved: 3 Sa •S6'/1/N O(,& /2 /1-7-e-4ACT/G
General description of improvements:• / if 6-ce„ Erp u-r F>Cr6-i21 /'e. 7 g./A! 3 2 L 33
I-E-ecyst c.c'/-1Ft-1 T
Owner: /4(CCM-6-i.... 7-(:)(4E--t E7 Address:35..J.4-1-r/Noce f2 A-TLsf,A(Tf c
Owner's interest in site of the improvement: 0 E4Cf,
Fee Simple Titleholder(if other than owner): 54.Z3 3
Name:
Contractor: (. f't. 44 le-APh, /1-i C , 70ftIfc,q-1/ 0/'LV47/A! G' /C
Address: /47 11/01Y&7 t L ox7Je,' 1 d sr• 9 01-1" ,5> 3 215-`f
%
Telephone No.: 0`7, 662.7717-r
6 2. 77 1 / 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
specified):
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M
ng
THIS SPACE FOR RECORDER'S USE ONLY OWNER 0 N
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Doc#2021226049,OR BK 19887 Page 1390, ;ned: –' Date: ( � �
Number Pages. 1 .fore me this ' I� da if l h .` `in the County of Du aWSitc,4
Recorded 08/30/2021 11:16 AM, p y ppOE
._
JODY PHILLIPS CLERK CIRCUIT COURT DUVAL Florida,has ersonall a eared
;�� J W
COUNTY >tary Public at Large,State of F,Lo ,C�W �`-�of Duval. m
RECORDING $10.00 y commission expires: N4 `os'=
�pr
'rsonally Known: =��
,oduced entification: L \. WO Lie0� :°i'. ..r':