67-Roof Permit 501 Atlantic 8-9-11 (00651595xBA9D6)CITY OF ATLANTIC BEACH
R
s)800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002468 Date 8/09/11
Property Address 501 ATLANTIC BLVD
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation 1800
Application desc
METAL PANELS FOR AWNING
Owner Contractor
GRFA PALMS LLC SCHULTZ ROOFING COMPANY INC
501 ATLANTIC BLVD,216 N. 20TH STREET
ATLANTIC BEACH FL 32233 JAX BEACH FL 32250
904) 246 -2315
Permit ROOF PERMIT
Additional desc
Permit Fee 60.00 Plan Check Fee 00
Issue Date Valuation 1800
Expiration Date 2/05/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 60.00 60.00 00 00
Plan Check Total 00 00 00 00
Other Fee Total 4.00 4.00 00 00
Grand Total 64.00 64.00 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: 1, -i t / I .Permit Number:
Legal Description //5 'gam /- =7S-1N € e:(4/1) '?Parcel # 7 ( %'F oor Area o Sq. 't.Sq.Ft
Valuation of Work $ 1 -nee. 6 Proposed Work heated/cooled non - heated /cooled
Class of Work (circle one): New Addition Alte Repair Move Demolition pool /spa window /door
Use of existing/proposed structure(s) (circle one):Commercial Residential
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval # 5.1, 1 ' 1 R2
For multiple products use product approvaiform
Describe in detail the type of work to be performed: k'S tb-1 t 6 S r C \1 CC(tY`P NC
fPcNC.1S e n T. 'cIer.i V1 c C CA NO? y ,
Property Owner Information:
Name: c":4 A&f Address:4' /g,)77g rgv.D
City If 1„ `- ( State /L,Zip- 2 Phone
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: Schultz Roofing Co., Inc. Qualifying Agent: Douglas A. Schultz
Address: 216 N 20 St City Jacksonville Beach, Fl. 32250
Office Phone 904 - 246 -2315 Job Site/ Contact Number 759 -0063 Fax # 904 -247 -3808
State Certification/Registration #CCCO36989
Architect Name & Phone #
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 initellations as indicated. I certini that no work or installation has ommenced prior to the
issuance of a permit and that all work will be performed to meet the standards ofall laws regulating construction in this jurisdiction. rmit becomes null
and void if work is not commenced within six (6) months, or if construction or work is suspended or abandonedfor a period ofsix 1 ; , , at any time after
work is commenced I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, toilers, Heaters,
Tanks and Air Conditioners, eta
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 F AANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BE ORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
1 hereby cert5' that 1 have read and examined this a plication and know the same to be true and correct. All provisions glows and ordinances governing this
type of work will be complied with whether speci red herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal, or local law regulating construction or the performance ofconstruction.
Signature of Owner / 974 /-' DIO'l' — 'Mature of Com, ct
Print Name p1444.Print Name VW A. Schultz, President
Sworn to and subscrib= % before m Sworn to and subsoriJargd before me
this / Day of AK .2, 0 /)this Day of ,4<,,,,,,, X201/
g
ota ublic tI'MCOMMISSION
am(r otary ' u • is tyr,.,,ry MY CO A EE 001736 fi ROS'L'iD CLARK
o EXPIRES: August 25, 2014 RIsiA4f` Bonded Thru N a: EXPIRRfh•wary Public Underwriters k Pf,VP Bonded TAru Notary Public underwriters