Permit Roof 30 17th St 2012 4 ``' CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
.4 ATLANTIC BEACH, FL 32233
° =��� € INSPECTION PHONE LINE 247 -5814
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Application Number 12- 00000074 Date 1/19/12
Property Address 30 17TH ST
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 4800
Application desc
reroof
Owner Contractor
DOWLIN ALL SEASONS ROOFING OF N FL
30 17TH STREET 3536 UNIVERSITY BLVD N # 187
ATLANTIC BEACH FL 32233 JA O 591-4044 FL 32277
Permit ROOF PERMIT
Additional desc . .00
Permit Fee . . . 75.00 Plan Check Fee .
Issue Date . . . Valuation . . . • 4800
Expiration Date . 7/17/12
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.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: / ' � / / % - 1ZiVeA Permit Number:
Leal Descri tion Parcel #
g p Floor Area of Sq.Ft. Sq.F't
Valuation of Work $ Proposed Work heated /cooled
non - heated /cooled
Class of Work (circle one): 4P Addition Alteration Repair Move Demolition pool /spa window /door
Use of existing /proposed structure(s) circle one): Commercial esid •
If an existing structure, is a fire spri er � installed? nstalled? (Circle one): es No N /A
Florida Product Approval # f 7 /�
For multiple products use product approval form
Describe in :(/)' *� Jam'/ vl��` ✓`�
n detail the t e of work to be performed aki/Pg
Property Owner Information: /�'
Name:.C%/ 1 � _ / / L A dress V t
City '// jG % . State Zip Phone "�D v'�
E -Mail or Fax # (Optional) 1
I
Contractor Information: , r,
l/ _ " /.f ' q // d ,, Qualifying Agent: / , '
Company�lame;/ � �
Address 6 !/1If +a � Cit `` pf State Zip
Office Phone 7%7 - . Jobe tpct Number Fax #
State Certification/Registration # 7ZZ 455.e ' ,
Architect Name & Phone #
Engineer's Name & Phone # n /
Fee Simple Title Holder Name and Address l U
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
ork sc o menced. I understand that separate permits or must be secured for Electrical - Work, Plumbing, Sig a Wells, months
Tanks and Air Conditioners, eta
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 ATTO R EMBEFORERECORDING YOUR NOTICE OF
I hereby certify that I 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 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 1. al law regulat' onstruction or the performance of v ,
Signature of Own
Signature of. . or 1."!2`— \`
Print Name 6/LL. 1 /9I+^ ` , �o C L / Print Name 27 y`0 V /4 -
Sworn d su scribed "ti f me Sworn 4 s subscr':k. before me 2^
this AMP 20 A- this d ay of /' 20
/ r / 1
� ,�
, otary Public r .ot
pEgORAH nMnNO� u5 3 y { E ,+ `" `'ei s DEBORAH AMANDA iNHfi e � 4 e 01 .26. t 0
MY COMM `s ?.. 4% .: MY COMMISSION # EE 05/3
4:11:17:[:1 ISSVON
I S EXPI n R iNS -
Ma "`�� �a• �- EXPIIRES. ,a 21 a r r C1
/t/
PERMIT NUMBER
NOTICE OF COMMENCEMENT
FLORIDA STATUTE 713.13
STATE OF FLORIDA
The undersigned hereby gives notice that improvement will be made to s P property,
and in accordance with Chapter 713, Florida Statutes, the following in
the Notice of Commencement
le::al description of the property, .street address if available).
^
1. Description f property: ( /4/1/6 j'
i f
2. General description of improvement: NIi ►I allir '1 o
3. Owner Information: "
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a. Name and address: /1/ a lt /' '' - o_
_
b. Interest in property: 0/A4/1, , ' co
0; 1-
c. Name and address of fej:n
' ple titleholder (if other than owner): _
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4. , etor (Nam and . d • ess r. Q c" r ce Z 5 •)t tti't.5i 1 ... L ' iE AIIIIM141,-49t N w z
b. Fax number:
u `, a.Phone number: ng�. ► [ —
C4 CT) 4 51 o LL z o
5. Surety: ° z O"
a. Name and address: ��
b. Phone number: c. Fax number:
d. Amount of bond: S
6. Lender: (Name and Address) 4
a. Phone number: b. Fax number:
7. Persons within the State of Florida designated by Owner upon whom notices or other documents
may be served as provided in Section 713.13(1)(a) 7., Florida Statutes: (name and address)
1 3/1
a. Phone number: b. Fax number:
8. In addition to himself, Owner designates
of receive a copy of the Lienor's Notice as provided
in Section 713.13(1)(b), Florida Statutes. year the date of
9. Expiration date of notice of commencement (the expiration date is one (1) y
recording unless a different date is specified)
ignature of Owne •.7 L N
( ice. >, 4 /�
Print Name
Swom to (or affirmed) and subscribed before me this ' d of 20 1_ , by
(Name of person making statement). .
2 (_, •
,I �` ` (<1
Signature of Notary - State of Florida
Seal , ..•"''t l ' DEBORR1AMAND
be ,.. ; MY COMMISSION: EE 057349
-- ` EXPIRES: May 21, 2015
• • ' Bonded Thru Notary Public Underwriters
Personally Known OR Produced Identification/Type