471 AQUATIC DR ROOF CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
ROOF PFRMIT
MUST CALL BY 4PM FOR NE1(T DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-1264
Job Type: ROOF PERMIT
Description: REROOF FL 1956.1
Estimated Value: $4,500.00
Issue Date: 5/29/2015
Expiration Date: 11/25/2015
PROPERTY ADDRESS:
Address: 471 AQUATIC DR
RE Number: 171818-5302
PROPERTYOWNER:
Name: LEIDHOLT, DEANE E
Address: 3125 NAUTILUS RD
GENERAL CONTRACTOR INFORMATION:
Name: AMERICAN ROOFING U-C
Address: 2625 SE HIGHWAY 441 QA DONALD SCOTT CHAPMAN
Phone:
FEES:
BUILDING PERMIT FEE $72.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $76.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATI�ANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODE&
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
900 Seminole Rould,Atlantic Beach,Fl,32233
Office(904)247-5826 F.(904)247-5945
J.bAddn.: 471 Aquell Dr, 32233 Perandt Number:
Legal Duseriptions 38-71 38-2S-29E AQUATIC GARDENS NrM# 171818-5302
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turf'ound struchurl one) Comormial Riondential
If an existing struc un,is a fin spr ir,,burnimmalled?(Circhatme): Yes No NA
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Descrilbe in detail the type of coork to be performuSI—Re-Roolf—_
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Deanei-E Leldholt Add. 98-1851 B KwElhurrhanu St
city Abuse StalliKiZil, 96701
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Office Phi Job Site Contact Number _Fnell—
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Architect Name&Phone 9
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I=Simple Title Holderbleme anal Address_,.NA
flooding Company Name and Acidicas NA
Mongolia Under Name and Addicts___NA
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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 RECORDING Y6U NOTICE OF
COMMENCEMENT.
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STATE OF HAWAII
SS:
CITY AND COUNTY OF HONOLULU )
On his -11_la 114Y 2015 before..pmsonally appeared
V,W, L',J�,JVI .to me kn�to be the person described in and
who executed the foregoing instrurnent,and acknowledged that he/she executed the same
as his/her free act and dmd.
L
TRACYS.LOGAVIA
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HmVPub awal.i
My commission expires: 9/V2015
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Legal description of property being improved: 38-71 38-2S-29E AQUATIC GARDENS
I
Address of property being improved: 471 Aquatic Dr,Atlantic Beach,FL 32233
General description of improvements: Reroof
Owner Deane E.Leidholt
Address 98-185 1 B Kaahumanu St,Aiea,HI 96701
Owner's interest in site of the improvement NA
Fee Simple Titleholder (if other than owner) NA
Name NA
Address
Contractor American Roofing of Jacksonville
1015 Atlantic Blvd,Suite 352,Atlantic Beach,FL 32233
Address 904-226-1205 Fax No. 904-425-9464
Phone No.
Surety(if any) NA Amount of bond $
Address
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name NA
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:
NA
Name
Address
Phone 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 Statutes. (Fill in at owner's option).
Name NA
Address
Phone 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 is specified):
THIS SPACE FOR RECORDER'S USE ONLY OV WVV INV EV-I DATE
Signed.. A
Before me this day of .. I "'T i�- -
County of Duval.-State of-F49Mel 'personally IMPPIM!"
slierelin
himself/herself and anirms that Call, en i an s 9110111111111111
Doc#2015125367,OR BK 17 185 Page 1772, are true and accurate
Number Page&2
Recorded 06/0212015 at 12:48 PM,