Permit Roof 64 Ocean 2011 s.s CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
otl, =M ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002732 Date 10/04/11
Property Address 64 OCEAN BLVD
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 2250
Application desc
REROOF
Owner Contractor
STEIGER BILL SIMPSON ROOFING, INC.
64 OCEAN BLVD. 911 CESERY BOULEVARD
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32211
(904) 744 -9238
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 65.00 Plan Check Fee . . .00
Issue Date Valuation . . . . 2250
Expiration Date . . 4/01/12
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: tp ' °Man aid . Mal/tic bea FL 32 2?�3 Permit Number:
Legal Description Parcel #
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ 2.2_5 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 Residential
Han existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performed: n vntf w .4-4h 441 v .c s1/1clo srt -4. S
Property Owner Information:
Name: M ,Ark' Ann .51 - eir Address: 33E5 94h Street
City Atbatic Peach State FI.. Zip !2n3 Phone (104. 211. 13
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: OI' '- 5 e r►..n a uv rc. Arc, .a- .,.'c` Qualifying Agent: i3 ; '- L s f ••t. P s.
Address: el it Ccs ie.. et. tl,L,v 4 City , J4 X State 1t Zip 3 7 z<. 11
Office Phone "7' %/- 9 Z 3 8 Job Site/ Contact Number q q 3 s - --1° if ei Fax #
State Certification/Registration # dc e 43 z- 4.3 3 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 ofa 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 a�period of six (6) months at any time after
work is commenced. 1 understand that separate permits must be secured for ElectricalWork, Plumbing, Signs, Wells, Pools, Furnaces, 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 cert that I have read and examined this . application 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.
Signature of Owner ,udr.. - Signature of Contractor .,,
Print Name .... C aro l e Ann ..5telc' f Print Name 13 ' --- --c, --,,es....„
Sw •» to and subscribed before me Sworn ,t/6 and s :. - 'b-d befo e me
i o ,C 7# ay of Sw -?7 A F,
.� � 20 I( this L{ of / �, 20 �
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otary Public Notary Pu. rc
ALIEN M01IN10
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NMMy ►wile- NMt Nttilt Revised 01.26.10
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