Permit Roof 741 Sherry Dr 2011 ' , CITY OF ATLANTIC BEACH
y ..c.- i . R
800 SEMINOLE ROAD
X ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
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Application Number 11- 00002510 Date 8/17/11
Property Address 741 SHERRY DR
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 5000
Application desc
REROOF
Owner Contractor
LINDLEY TOLBERT DESIGNS BLALOCK ROOFING, INC.
465 BEACH AVENUE 10737 NEW KINGS ROAD
ATLANTIC BEACH FL 32233 SUITE 106
JACKSONVILLE FL 32219
(904) 766 -6190
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 75.00 Plan Check Fee .00
Issue Date Valuation . . . . 5000
Expiration Date . . 2/13/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 75.00 75.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 79.00 79.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
09 -
CITY OF ATLANTIC BEACH
ROOFING PERMIT APPLICATION
Date: W k (
Job Address: ! Y' /9 'f-- tu'-- -.---
Owner of Property: _- aLl �� (��L V1
Address: Jr67 .., � a ' , '3L2. t
. Telephone: _L9_04-) � -J '
Roof Contractor: 0141 OCR., RO ?T +,1 -�.YAG
C � State License Number: e( �, r 7 I ).
Contractor's Address: O 1 r
� � • 1 ins , {. �Z . x L a.
Telephone:909 '1 Cj() Fax: 'Qti^7( -4 'iii Email:
Scope of Work: re .. gtel $ fi n b c kC -o (n ' Roofing Material Yfle }4, e4.4 e
FL Product Approval # ' (D J I d Valuation of Work: $ J no v
Required Inspections: Sheathing /In Progress -Dry In / Final
lc 13
If re -roof: Assessed Value of Structure: ,j< $ Roof -to -wall improvements required? no
( Applies to single family structures only)
"WARNING TO OWNER: YOUR FAILURE TO RECORD NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT Y r UR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT"
Signature of Owner: Date: bill /1
AS TO OWNER:
Sworn to and subscribed before me this 1/ day of 4 9 1 0.5 - 1 - , 20 / r .
State of Florida, County of Duval
WILLIAM L POPE
Notary's Signature: / �t, ` ��.L -
Notary Public, State 01 Florida X. Personally known
My Comm. exp. Oct 19, 2011 Produced identification
AS TO effr C981?:
Type of identification produced
Sworn to and subscribed before me this � Ems day of _..�
20 /
State of Florida, County of Duval
Notary's Signature 1
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PerSa t sown
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roduced id o S
.. Art / , � / Type of ide ixc . ,O r HI•� GRAHAM
xutP A141�:
EXPIRES: F b 14, 2014
P Bonded Thru Notary Public Underwrit I
800 Seminole Road • Atlantic Beach, - - --
ers
Telephone: (904) 247 -5800 Fax: (904) 247 -5845