Permit partial roof 2010CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
Application Number 10-00000973 Date 8/04/10
Property Address 28 17TH ST
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation 1000
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Application desc
2.40 sq
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Owner
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OCCUPANT
28 17TH STREET
ATLANTIC BEACH FL 32233
Contractor
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SHORE ROOFING COMPANY
914 7TH AVENUE SOUTH
JAX BEACH FL 32250
(904) 241-8842
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Permit ROOF PERMIT
Additional desc .
Permit Fee 55.00 Plan Check Fee .00
Issue Date Valuation 1000
Expiration Date 1/31/11
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total
Plan Check Total
Grand Total
55.00 55.00 .00 .00
.00 .00 .00 .00
55.00 55.00 .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
__
lob Address: ~ ~ / ~ -~ - l
Permit Number
regal Description Parcel #
Valuation of Work $ ll~t~D ~ ~= proposed Work heatedlcooled non-heated/cooled
Mass of Work (circle one): New Addition Alteration Repair Move Demolition pooUspa windowldoor
Jse of existing/proposed structure(s) ((circle one):. Commercial Residential
[f an existing structure, is a fire s riniCler s stem installed? (Circle one): Yes No N /A
ilorida Product Approval # =~ 3 -~. ~ ~ ~ 3 ,.~~r Z-
~or multiple products use pro uc approva orm
describe in detail the type of work to be performed: __ ~ ^•'S ~''~ ~ ~ .~ i `f ~' S ~~ / ~ L`, ~ 7 -~/
?ro er Owner Information: >
~7' '
Name: I'Y1 CIS - ~ ~ Address: ~ ~ ~ ~ ~' ~ S'~-_
~ity ~- State~~ ip "22. ~ Phone
Mail or Fax # (Optional)
contractor Information:
~ompany Name
n,ta..o~~. (''~ , ~
Qualify Agent: ~~ti-, ~~.~
City -r State ,~ ^t Zip ~ " Z ~
J~ce Phone •- ~ 8 L_ Job Site/ Con~ct umber Fax # ~ t~~_ ~6~~
Mate Certificatio egistration # ['_ C (° ~ fit/
4rchitect Name & Phone #
engineer's Name & Phone #
?ee Simple Title Holder Name and Address
3onding Company Name and Address
Mortgage Lender Name and Address
4pplication is hereby made to obtain a permit to do the work and installations as indicated. I cert~ that no work or installation has commenced prior to the
ssuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
rnd void f work is not commenced within six (6) months, or if construction or work is suspended or abandoned for aperiod of six 6) months at arty time after
vork is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, ~urnaces, Boilers, Heaters,
Tanks and Air Condltiorters, etc
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.
r hereb cert~ that I have read and examined this placation-and know the same to be true and correct. All provisions of laws and ordinances governing this
ape o,/Ywork will be complied with whether speci red herein or not. The granting of a permit does not presume to gyve authority to violate or cancel the
~rovisrons of any other federal, state, or local law regulating construction or the performance of construction.
signature of Owner
Print Name -~,~ _ v~~ J ,~
Swo and subscribed b e me ~~
:his y of ••
=Lntiis`,.~ .. I t7r11t1~
1 .C ~ ~ ,: G it 634126
VOtary PUbIIC ~~~~~~~~ 9ondedThruNoteryPublicUnderwriters
Signature of Contractor
Print Name ' % ~ ,.,,, r.->.s ~ ~~ ,, ---_
~~-
NotaryPublic Underwriters
Revised 01.26.10