Permit Roof 890 Orchid 2011 ,0 CITY OF ATLANTIC BEACH
1 ` , ,-" sy 800 SEMINOLE ROAD
' "" ATLANTIC BEACH, FL 32233
, ;_ INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002662 Date 9/21/11
Property Address 890 ORCHID ST
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 2400
Application desc
REROOF
Owner Contractor
FOURAKER HERBERT C H C FOURAKER INC (ROOF)
POST OFFICE BOX 50528 POST OFFICE BOX 50828
JAX BEACH FL 32240 JAX BEACH FL 32240
(904) 813 -3308
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 65.00 Plan Check Fee .00
Issue Date Valuation 2400
Expiration Date . . 3/19/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 65.00 65.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 69.00 69.00 .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: gt9 OA-t,.ct -S ; Permit Number:
Legal Description Parcel #
Floor Area of Sq.Ft. / /PD Sq.Ft
Valuation of Work $ 2-f/O Proposed Work heated /cooled non - heated/cooled
Class of Work (circle one): New Addition Alteration 'Ilir Move Demolition pool /spa window /door
Use of existing /proposed structure(s) ( circle one): Commercial Res
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval # % c.. x yy y
For multiple products use product approval form
Describe in detail the type of work to be performed: Rea. Coe= — sh 4 .1 7 .. :
Property Owner Information:
Name: l .S. C _ C- ( -Owtik, e•-v A.- Address: P. D. Igt= A- cd $' rSr
City 07,4C State fc.Zip 3Lt yo Phone apt se - O
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: A • • 3 C.- • , . • Qualifying Agent: ,4 e•"---
..—
'
Address: 7. . tea,.. s DsZr City i c4ce- State
Office Phone 98 y -Ci1 - 33 a$ Job Site/ Contact Number Fax # "--e. Zip 3 Lz�
State Certification/Registration # C C c, o S 3 y/
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. 1 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 aperiod of six 6) months at any time after
work is commenced. 1 understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, F urnaces, Bo 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 I have read and examined this a plication and know the same t; be true and correct. All provisions of laws and .: ' • - -ruing this
type of work will be complied with w. -ther s eci ied herein or not. The gran ' fi of a permit does not presume to give autho to vi �
violate or c. •cel the
provisions of any other feder. . • or loc., l' w re g constructi g r on or t .erformance of construction. / , iiiii
Signature of Owner �� // / _ /,/,/ , (�
Signature of Contract. , / �
Print Name NIS rpm • ‘---. Print Name {. 4, .,4
Swor o . ., ubscr I. e. befor- -or Sworn • . : .. scri . ed before -me -- I
this ■ ../ I . of - - - -- �
-- : — this .....4 '� b = __ "' 20
71 " 1 rill ` . t rl•!t� Y CO Ire . . , . D 957760 I mirg, LEY L r iss - . . ,
Notary Nota - .. IC :onded Thr - Notary Public Underwriters I Notary ;
- -- J ' U rse p onded Thrui Public Underwriters I
evise. I 6.10