Permit Roof Repair 815 Atl. blvd 2011 - i'.,: t
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fi Ss' CITY OF ATLANTIC
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C BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
19? INSPECTION PHONE LINE 247 -5826
Application Number
Property Address . . • • 11- 0 0001705
Application type 815 ATLANTIC BLVD Date 2/22/11
ype description ROOF PERMIT
Property Zoning .
Application valuation To BE UPDATED
----- -- - - - - - - suss -- 400
Application desc __________
- -- _REPAIR _ROOF _UNDER _MECHANICAL EQUIPMENT
Owner ---------------------------------
Contractor
PIZZA HUT #59594 'suss -- suss__ _
ACCOUNTS PAYABLE GIL CLOUTIER RRRR (ROOF)
P.O.BOX 2938 3143 WALLER ST
WICHITA KS 67201 JACKSONVILLE
----------------------- -- -- -- (904) 591 -3231 FL 32254
Permit . . ROOF PERMIT -_-- - s uss -- _
Additional desc ROOF REPAIR UNDER MECH EQUIP
Permit Fee Q
Issue Date 69.00 Plan Check Fee
Expiration Date Valuation
.00
- -- suss -- 8/21/11
suss -- - suss 400
------------------ - - - - -- ________
-- _ __
suss -- ________
--
Other Fees STATE DCA SURCHARGE
________ ______________ STATE DBPR SURCHARGE 2.00
------ - - - - -- ____ -------- suss --
2.00
Fee summary Charged Fee summa Char Paid Credited --- suss suss --
Permit Fee Total - - -- suss -- Due
Plan Check Total 69.00 69.00 .00 .00
.00
Other Fee Total 00 • .00
Grand Total 4'00 4.00
73.00 ' .00
73.00 .00
.
.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: ? S ,
Legal Description
v'i. Permit Number: ,'' 0.s
Valuation of Work $ 00 °° oor A rea o Parcel #
P roposed Work h /cooled
n o n - heated /cooled
Class of Work (circle one): New Addition Alteration
Use of existing /proposed structure(s) (circle one): Repair Move Demolition pool/spa window /door
If an existing structure, is a fir �der Florida Product system insta : Residential
Approval QS + 7
one): Yes No N /A
For multiple products use product approva orm
Describe in detail the type of work to be performed:
Pro 1 e Owner Information:
Name: / / 24
City j� � Address: g /,,,r74t- Reg •
Statekl-
E -Mail or Fax # (Optional) Zip " ;:b. Phone _ .- "s
Contractor Information:
Company Name: I ` C < ov"17fe( R I`? P2
Address: 3lY t,'4 c Q�ali Agent: t �/3�2/ C (O F71
'a S' `/_ Job Site/ C4�tact Number JJ` State
State Certification/Registratio # C C • ------- - / - 3a3� Zip 3 SZ
Office Phone
Architect Name & Phone # Fax # 9 d y 36 -S-02 0
Engineer's Name & Phone #
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certj that no wor k or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This
and void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned or a period
work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, ells Si n s y� , Pools, Furnaces, Boilers, Heaters,
becomes null
w an anks and Air Conditioners, etc. 1 rod o o six (u) mo at any t h e eateto i rss, ,
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT ROVEMENTS
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR OT WITH
COMMENCEMENT. CE OF
I hereby ertify that I have read and examined this a plication and know the same to be true and correct. All provisions of ty vto laws and ordinances o
type of work will be complied with whether speci red herein or not. The granting of a permit does not presume to give au t_ to
orovisions of any other federal, state, or local law regulating construction or the pert rm nce of construction. late g or verni el th this e
Signature of Owner C71 5 d
Signature of Contractor A _�
°tint Name
Print Name Cl < 8E ti C C O ,ffie n
worn to and subscribed before me
his Day of , 20 Swo 1 subscribe ek - / ,- me
this ay of L�:4. ..... 20 /// / /
lotary Public ��'� -- � e _ ��
No ?"t!, is .- D MMI$S I A�WHf6E
L * • , MY COMMISSION N DD 8341
o , EXPIRES; May 21, 201 A. 4 sed 01.26.10
`� �„ !WOO Thru Wary Publk Um10rwriton �