Permit Roof 1879 Beach Ave 2010 � CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J . ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 10-00001249 Date 10/13/10
Property Address . . . . . . 1879 BEACH AVE
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 5963
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Application desc
REMOVE AND REPLACE ROOF ##FL183
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Owner Contractor
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PETRONI, GERARD AAA ROOFMASTERS INC
1879 BEACH AVENUE 2446 TYSON LAKE
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32207
(904) 639-8766
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Permit . . . . . . ROOF PERMIT
Additional desc . . REPLACE ROOF
Permit Fee . . . . 80 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 5963
Expiration Date . . 4/11/11
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 80 . 00 80 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 84 . 00 84 . 00 . 00 . 00
PERMIT 1S 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
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Job Address: Permit Number:
� � I � ��-f�� ill'L, � I
Legal Description Parcel#
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) ((circle one): Commercial Residential
If an existing structure,is a fire s r�nitl r system installed? (Circle one): Yes No N/A
Florida Product Approval # ^ l
For multiple products use product approva orm
Describe in detail the type of work to be performed: �e�_ 00 f-
Property Owner Information:
Name: Address:
City aLLzState ip31Z37 Phone – &ql;g
E-Mail or fax-# (Optional)
Contractor Information:
Company Name: C- Qualifying Agent: b446/0 IVl _—LeA,�//J
Address: E d T' city 4Ct AWILLC. State Zip 3FZe
Office Phone 113 – `Z1pto3 Job Site/Contact Number 9) 0 3 Fax#
State Certification/Registration#
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 installations as indicated. I certify that no work 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 permit becomes null
and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six(6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells,Pools, Furnaces,Boilers,Heaters,
Tanks and Air Conditioners,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.
1 hereby certify that 1 have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
type o work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction.
Signature of Owner Signature of Contractor
Print Name 1...1. �........VD.1...........psfmnz. ................ Print Name ......1.✓ �. ......,,r'... t!r ....................................................
ubscn ed before me Sworn to and su _ , before me
this Da of ( , 201 D this b ® e oc�n„@ 20
Sworn o an s
4E14M FER S PERDUE '- MYCCr„I'hoSSION# 769662
Notary P : = Y Cc� �°,SaSSION# 69662 Notary P b ,,,
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7)3980153 �`_`8-Revised
1 7)398.01 01.26.10
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Number Pages 1
Recorded 10 93`2010 at 01'23 PM,
Mt UWDUSMU UERWGWICS" 7=TRATnQ*OV a WrWILLstMADtTOCnTAL' JIM FULLER CLERK CIRCUIT COURT DUVAL
REAL PROPERTY.AND IN ACCORDAPK I w7 m C11Ar reR 73.nziuDA srA?V rM TAt COUNTY
FOLIAWU4 0(FOttI"nm is PROYIDtD L4 THIS 40=t OF COIAMLIYCDALKP. RECORDING$10.00
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PERSONS VATHTN Tfs STATIC Of FLORIDA DtSKa1ATED•Y OWNER GPM WWK NOT X=OR OT MCR,DOCUPOM s MAY BE
SERVED AS PROVIDICD BY SICCTWH TW3(T)(A)7.PLOR104STATVII*
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1*1 ADDIMN TO MWISO.rOR RaasaX O N=Dts1<.YIATEa
OF TO R==n A COPY OF TM tdtlW""O"M AS PROVIDED IN$WrM 7Mtd(t IRI.FLORIDA$rATVrW
PIWN VMS=OF MMM OR> MTV*WCHATn XV 01YfRIG
WARMNG M-QMML, ANY PAYIrWM MADE BY TBE OWMM AFTER THS ff"IRATION OF THE
NOTICE OF COMMZNCZMMNT ARE CONSWZRZD 09%OPER PAYMENTS UNDER CHAPTER 713,
PART 1,SECTION 713.13,FLORIDA STATUTZS,AND CAN RZSULT IN YOUR PAYING TWICE FOR
IMPROVEMEIM TO YOUR PROPERTY. A NOTICE OF ODD04INCV49NT MUST BE RECORDED
AND POSTED ON THZ JOB SITE MWORE TU VMS INSPECn()M Ur YOU WIND TO OBTAIN
FINANCING, CONSULT VKITH YOUR LENDZR OR AN ATTORNEY BEFORE COMMENCING WORK
OR RECORDING YOUR NOTICE OF COMI WCRK9NT. UNDER PENALT= OF PERJURY, I
DECLARE THAT I HAVE READ THE FOREGO[NG AND THAT THR FACTS STATED IN TT ARE TRUE
TO Z BEST O M'Y KNOWI.BDGt AND BZU".
Pritd Name of Paaaa Slawks Abra is Gwaq(Yso.ed Of State
S�TATs OF FLORIDA CO(MTY Ox D� I JENNIgFESDUE
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Form N N 1 Revised May 1.2006 c,0