Permit Roof 80 Ocean 2011 !• =��Jr
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 11- 00002736 Date 10/04/11
Property Address 80 OCEAN BLVD
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 2250
Application desc
REROOF
Owner Contractor
FULLER BILL SIMPSON ROOFING, INC.
80 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.
f BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: t" 0 OC 971/ 8 LW Permit Number:
Legal Description Parcel #
Valuation of Work $ Z L S'b P Work h ted /cooled n 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
If an 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: 14 A. ad d vc La 4 w t i a
14 par R 'E c-,z A.- ...r_.
Property Owner Information:
Name: /?0Y3 /1 1–O Address: 6 10 U"GL1/t) 8 L1) 0
City 4 twettyll C (Si State FL Zip 3:4233 Phone .2- li g - SW y 7
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: i) i ` 5 es-0 R a d r , ,,, v .7, Qualifying Agent: ( 's . – Si Ps 0-
Address: S it LC s Evt g (.... i! b. City Dolt: State F■ Zip »3 i
Office Phone 7`N et 2, 3 Y Job Site/ Contact Number I q 3 S$ c Fax #
State Certification/Registration # Lc c 13 2-- 4 3 3 s'
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 if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a of six (6) months at any time after
work is commenced. I understand that separate permits must be secured for Electrical IYork, 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.
I hereby certify that 1 have read and examined this a plication 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 spe ; d 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 lo .. PI, / egulating construction or the performance of construction.
Signature of Owner , , -
Signature of Contractor , .r1 -....aim ;
Print Name lfc 64 A FP Lt C_=- Print Name 0 i 4, s, ,.v,, P 47,.../
Sworn to and subscribed before me Sworn • and subscribed •,- for- me /
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,per i Notary Public Stab of Florida N s ' "ti' • , ;' 5�
`; Dayna H W 'F pF � .. ... -d?hru No . ublic '
�{,,� l My Com EE118875 °' "�" Revised 01.26.10
` ,vdr Expires 08/07/2015