Permit Roof Repair 892 Ocean Blvd 2011 tr n ` CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
J ii 4 .,„, - ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002097 Date 5/17/11
Property Address 892 OCEAN BLVD
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 675
Application desc
REPAIR TILE ROOF
Owner Contractor
HARRIS, BOB KEN WELLMAN COMPANY INC
892 OCEAN BLVD. 2941 EDISON AVE
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32254
Permit ROOF PERMIT
Additional desc .
Permit Fee • • • 55.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 675
Expiration Date . 11/13/11
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
fob Address: ? 9t- A") (9t✓9 Permit Number:
regal Description Parcel #
� " o Floor Area of Sq.Ft. o n- heatedlcooled
Taluation of Work $ (.r( Proposed Work heated/cooled n
;lass of Work (circle one): New Addition Alteration ' ep. ' • Move Demolition pool/spa window /door
Ise of existing/proposed structure(s) (circle one): Commercial '
f an existing trructture, is a fire sprinkler system installed? (Circle one): Yes No N /A
lorida Product Approval #
'or multiple products use product appro avav or
>escribe in detail the type of work to be performed: 4.�'4 r ¥c \K- J
'ro . e, ,. 1 er e. orm . 1 : /,
' ‘ c -,1.2 -4( ` V
1. i t . _ ' y v ` tat- . A Zip: 2 Phone
-Mail or Fax # (Optional) (
ontractor Information: 1,
— N L . , Qualifying Agent: 14.,J^�Z'`^ 42 - .CL 4
ompany Name: ✓ ' State' Zip 3 ?? l
ddress:. A a .'�� //� --^� City i �k
ffice Phone 1?j L
Job Site/ Contact Number Fax #
tate Certif catio I ' egistration #
rchitect Name & Phone #
agineer's Name & Phone #
1e Simple Title Holder Name and Address
onding Company Name and Address
[ortgage Lender Name and Address
�p uance f is e r m e t and that all work will be to o meet the standards of all indicated.
aws regulating construction in this jurisdiction.Th s permit becomes
n unce of w p ( at
:d void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned far a�e lls � Po o ls x l�'u T naces � Bo i� , Heaters,
)rk is commenced. I understand that separate permits must be secured for Electrical Work, Plumbin , Signs,
inks 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 IN EFORE REC ING YO C E OF g
YOUR LENDER OR AN ATTORNEY COMMENCEMENT.
ereb certify that I have read and examined this a plication and know the same to be true and correct. A ll provisions of laws and ordinance gover this
)e of work will be complied with whether specid herein or not. The granting of a permit does not presume to give authority to violate or cancel the
9 of any other federal, state, or local law regulating construction or the performance of construction.
gnature of Owner
rn tc� U �y Si gna t ure of Contractor _ t
L \ v t L , S P Name /� "i
int Name p S2 - I . 9 Atli✓ : t .. • � G 1 1 \\ ` \,\` p, \E T � i Mp �� �ir�
vo and subscr'.e• b- ore me \\ \�� 0 mini'; j Swo to o ansubs .e,ore me \ \ ���, r QQ;� � T'� '•
is / 7 Day of 1 .�./� \ _ , >%
�, ; Notary Public „ ; #DD 9 7211 4 O
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#D � 972 1 1 4 , . Rev 0 "' •r • 6 1.
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