Permit 191 12th Street CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 10-00000599 Date 5/12/10
Property Address . . . . . . 191 12TH ST
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 1940
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Application desc
REROOF DETACHED GARAGE
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Owner Contractor
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CURRIER JONATHAN & TERESA ATLANTIC COAST ROOFING AND
TITHERINGTON IRENE - TRUST CONSTRUCTION
191 12TH STREET 1008 LORING AVENUE STE 14
ATLANTIC BEACH FL 32233 ORANGE PARK FL 32073
(904) 396-4005
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Permit . . . . . . ROOF PERMIT
Additional desc . . REROOF DETACHED GARAGE
Permit Fee . . . . 60 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 1940
Expiration Date . . 11/08/10
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Special Notes and Comments
REROOF FOR DETACHED GARAGE ONLY
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 60 . 00 60 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 60 . 00 60 . 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: 19112" St Permit Number:
I#
11 16 21, 1 E MandalaY
Legal Description 9 Parce
29"_ M'
r Sq.Ft
or a o
o
ropos I Wor cooled 0 non-heated/cooled_-AO—O
Valuation of Work 1940.00 roposed Work heat
Class of Work(circle one): New Addition Alteration Repair M emolition pool/spa window/door
Use of existing/proposed structure(s) circle one): Commercial Z:sidential )
S %,
if an existing structure,is a fire spriler system ins Bed? (Circle one): s 0
Florida Product Approval# r-L, to(o .14.
For multiple products use pro-du approval form /,Ao
Describe in detail the type of work to be performed: Re roof garage
Property Owner Information:
Name: Irene Tithering—ton, Address: 19.1.12d'St
City —Atlantic Beach. State FL—Zip 32 !33 Phone: 904-249-8257
E-Mail or Fax#(optional
Contractor Information:
Company Name: Atlantic Coast Sales&Service Qualifying Agent: Bradlgy K.Clark
Address: 5909.St.Augustine Rd. Suite 2___�City Jacksonville State FL Zip 3220
Office Phone 904-386-4005 -Job Site/Contact Number Fax# 888-599-5713
State Certification/Registration# CCC057666 4
Architect Name&Phone# AA.
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address VT - A
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 I certify that no work or installation has commenced prior to the
issuance ofa permit and that all work will be performed to meet the standards ofall laws regulating construction in thisjurisdiction. This permit becomes null
six(6)months, or rfconstruction or work is suspended or abandonedfor a eriod ofsix(6)months at any time after
W,
Si ns, P
and void ff work is not commenced within edl�, oW kirnaices�BoUen, eat
work is commenced I understand that separate permits must be securedfor ElecWcal-Work,PfimNng, j P F H em
Tanks and Air ConMoners,dc.
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 YOUR NOTICE OF
COMMENCEMENT.
I here certify that I have read and examined this aMication and know the same to be true and correct. All provisions oflaws and ordinances governing,this
Vlwork will be com lied with w rS ciftied herein or not. The granting of a permit does not presume to give authority to violate or cancel the
p loc ofconstruction.
provisions ofany otherfederal,sta hethe re lating construction or the peFformance
Signature of Owner Signature of Contracto
Print Name ...........
Print Name ......... ...... .................... ....kput_e_�.......... ..........
,�� C_ b2_%%3C1L-_ UC R-23.4- 1444 F1�4 DQ_10fa L.Ic- r_4(e-^k 041
Sworn to and subscribed before me Sworn to and subscribed before me
this /� Dayof -MAu 2010 this I;, Day of _rn 20 10.
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MY COMMISSION 4 DD643668 Y CO�
gr EXpIRES:February 25,2011 F EXPIRFS-February 25,2011
FI.Notary Discount Assoc.Co. evised 01.26.10
Fl.Notary Discount Assoc.Co �%.N^TARy
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