Permit Roof 367 7th St 2010 J }
CITY OF ATLANTIC BEACH
` s) 800 SEMINOLE ROAD
'-> Z ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
Application Number 10- 00001386 Date 11/17/10
Property Address 367 7TH ST
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 750
Application desc
ROOF REPAIR
Owner Contractor
SMITH, LINDA REGISTER INTRACOASTAL ROOFING CO.,INC.
367 7TH STREET P.O. BOX 10816
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32224
(904) 398 -6675
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 55.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 750
Expiration Date . 5/16/11
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 55.00 55.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 59.00 59.00 .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: ,367 71h Si-Yee T Permit Number: a 3 ..
Legal Description Aa B /OC t dim..
t o 9' G,C e`t Parcel # l6 9 / 7 e��
r Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ 75t 00 Proposed Work heated /cooled non - heated /cooled
Class of Work (circle one): New Addition Alteration Mk Move Demolition pool /spa window /door
Use of existing /proposed structure(s) (circle one): Commercial : M�
If an existing structure, is a fire spri • nkler system installed? (Circle one): 'es 4 0R. N /A
Florida Product Approval # /L /D /aYi /t
For multiple products use product approval form •
Describe in detail the type of work to be performed: / /� eYkv Cell e- 1 tO /t e _ ...44 Q etit e- 4- !
fa,lte, FI 6t , 4, . / f shih /e.i 3�
(ahoy q�.a.e , Jr ii,_ehzebe LJ /y 4e /eel
J Mod Q.c.L.i�v�n tial I�ZZp,1dB Pi. 6 7i.?./).
Property Owner Information:
Name: ;e12. Sa .�A// 4l Address: 367 7r% St
City /o»►/ic State gZip3. $3phone goy/QV( -257s-7
E -Mail or Fax # (Optional)
Contractor Information: f .
Company N. �: " e " = " 41.54//e 6 ,0 ff e Qualifying ' .ent: / I. �eefee D
Address: ' :., - .Z6 , City ■./44 . 5 4:3 -0- 14-V ' '" State .L Zip 3o?62 C
Office Phone A i 3A :-!.' i — Job Site/ Contact Number I / 746 3 - if Fax # /
State Certification/Registration # — 60va Q j
Architect Name & Phone # / V /A
Engineer's Name & Phone # /1) //M
Fee Simple Title Holder Name and Address N //Q
Bonding Company Name and Address , l) )
Mortgage Lender Name and Address ��
Application is hereby made 10 obtain a permit to do the work and installations as indicated. / certify that no work or installation has commenced prior to the
issuance of 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 u period of six /6J months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Plumbing, Signs, Wells, Pools, Furnaces, Furnaces, 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 7he same to he true and correct. All provisions of laws and ordinances governing this
type o work will he complied �Y ith whether sppeci ted 'rein r not. The granting ofa perm does not presume to give authority to viol, , ca e
Signature of Own
g
provisions of any other federal, 6tate, or local reg, `i,ng 'nstruction or the performance of construction.
Si ( � / / U I % iI . " Signature o /
� of
Ivy ' I I
Print Name 0 4 R A- 1Q 4 /T , Ca_ c
......... � ..............r . t ....L...................... Print N ame / r Cc d
Sworn to and subsc�ry ed efore me Sworn ip and s i before l ID B. • GE
this Day of AVM V 0 20 10 this /S /Day of: I s.) .A.,..,,. ,1:,,e, 11:: x. 0/O
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r� / t- 1, J. ' I . . November 1 .. 2014
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