Permit Roof 571 Seaspray 2011 , `T j CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
t �
j ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002573 Date 9/01/11
Property Address 571 SEASPRAY AVE
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 8600
Application desc
Reroof
Owner Contractor
TUSCANA, DAMIJAN K. EMPIRE ROOFING SALES & SERVICE
571 SEASPRAY AVENUE 2806 -1 GIBSON RD
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32207
(904) 391 -1007
Permit ROOF PERMIT
Additional desc . REROOF
Permit Fee . . . 95.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 8600
Expiration Date . 2/28/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 95.00 95.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 99.00 99.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
4-1, —
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: 5 7 1 Se y 1 4v '. AH n )i . g.,,..i., rl Permit Number:
Legal Description 3S- ( I 17 "AS - 2 E Sf sp v t Parcel # 170 70 - 0 30 1
1
Floor Arta df Sq.r't. Sq.Ft
Valuation of Work $ 2 p 0 0 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 esidential
If an existing structure, is a fire sprinkler system installed? (Circle one): es N /A
Florida Product Approval # Ft / O67
For multiple products use product approval form j
Describe in detail the type of work to be performed: l eq v P e d eck ,iic f y G+' or t ft' H em woo d
qv) '44(15 i hS7n (f 1 ( 4 t �-iv t- skihat'es CA th.
Property Owner Information:
Name: De••.n: . v.A. w -1 v6t ems... Address: 6 1 ( Sew g p re.-‘( •,+ 4
City IA A- l w}t a V e..t State F- Zip 3 Li. 3 3 Phone or o 4 1 - 6 Ts - 3 f de 3
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: iC'rvi rt. R00 (i�r Qualifying Agent: Pedro 'a sii ,2.
Address: ? 'O6 -f 6 so' 4r']. City .)rrr...krc,,V,jl e. State 1 1. Zip 3.
Office Phone 311 - l ap 7 Job Site/ Contact Number 2 ce q - d X it Fax # 3ert —1 14•?
State Certification/Registration # CCC. 1,3 2 Coo 1
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 f work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a _ penod of six f6) 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
COMIVIENCEMENT.
I hereby certify that I have read and examined thisplication and know the same to be true and correct. All provisions of laws and ordinances governing this
type of 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.
X . ature of Owner s _ 'L, Gn +uPr C. ' ) M. Signature of Contractor ilkir--
Print Name L_.) 11. \. S e ( Print Name Pedro d., i t, ..
Sw• . to and subscribed before my Swo . A�,nud subscrib; ' before Ile
thi Day of b'?'.Z. 20 \ this `S`Day of _ 20
4 4 ( 4e . (k)(Adt
No . Pus is ,_,;,.i B. WHITHAM Not: r ,: oft B. WHITHAM
.'uuhlic, State of Florida Notary Public, State of Florida Revised 01.26.10
exp. June 19, 2013 My comm. exp. June 19, 2013
,,,H,,;ir. No. DD 894859 Comm. No. DD 894859
.- -' _ _ _ . ___� • ... _� ooc�/unsnroau�a^`��» Page '1892, -`..,-.
Recorded "9/u/uu 1 at12o2 PM.
COUNTY uuR/ouvA,
RECORDING $10
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Name of person \-vilhin the Static cf Florida, nther !han himself, designated by owner upon whom ncticos or other
docurnenls may be served:
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/nauumun/u himself, owner designates mefollowing person mreceive a copy »/mcurnu/ Notice a, provided .o
_-_____-_5.eCtion 7]3.06J21(b S/alutes1F)11 in 21 Owner's »Ptic^:_. ____
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