Permit Roof 419 Whiting 2012 '.1
,`s 1�Jy
. 1- \ CITY OF ATLANTIC BEACH
Is- 800 SEMINOLE ROAD
'" ATLANTIC BEACH, FL 32233
���, c INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000160 Date 2
Property Address 419 WHITING LN 2/08/12
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 5000
Application desc
REROOF
Owner Contractor
LEDFORD REX E. ROMANO BROTHERS ROOFING, INC
419 WHITING LANE P.O. BOX 33037
ATLANTIC BEACH FL 32233 ATLANTIC BEACH
FL 32233
(904) 246 -5649
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 75.00 Plan Check Fee
Issue Date .00
Expiration Date . Valuation 5000
8/06/12
Other Fees STATE DCA SURCHARGE
STATE DBPR SURCHARGE 2.00
2.00
Fee summary Charged Paid Credited
Due
Permit Fee Total 75.00 75.00 .00
Plan Check Total .00 .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: Cr � Gj ��;, f L,V, Ai: , ;� ( Permit Number:
Legal Description Parcel #
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ 0'6, Proposed Work heated /cooled ,0 non- heated /cooled
Class of Work (circle one): New Addition Alteration Repair o molition pool /spa window /door
Use of existing /proposed structures) ) (circle one): Commercial Reside ' ---..,
If an existing structure, is a fire spr system installed? (Circle one). es No
Florida Product Approval # e
For multiple products use prod ct approva orm
Describe in detail the type of work to be performed: 5. i.,;i ,,r, A _ ' `— �,0 ' S/4 p
3 6 t i,-c N r A M k-Go
Property Owner Information:
Name: 14 K Address: T" ( C( i 0 /4-y,J S ,<„,4(._ City 4 1.4 P •e' - t 4 State rt. Zip 3 2'Z 7 -; Phone
E -Mail or Fax # (Optional) i
I
Contractor Information: (�
Company Name: (ti o ■� vi n (3,d14, c1�0 r� ti Quali fi ing Agent: 1 aw 0 mac �� N
Address: j J 1,v‘.5--f q 1-1 a' 1 I l r / 0 Ci a=� .,> Q,ti" J State l' 1 Zip 3 ZZ 33
Office Phone g oy 2 ii 6 56 V I Job Site/ Contact Number a, 541 59 q g Fax #
State Certification/Registration # C (.t 1) - n $4
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 conznzenced prior to the
and
a void f wor k is commenced within six (6) n�onths
or c o structionor of is sus e nd d or abandoned for ap of six risdiction(6) months at n v time of er . This work is commenced. I understand that separate permits must be secured for Electricar 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 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 conzplied 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 re lacing construction or the performance of construction.
f27 L3 /6 - S - 7 a > 4_ 0
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' � gnature o f Cora . t:
Signature of Owne —
J �, �r
*'� MISS 'i
x. - - zed ,z Print i _ :
� .. wn ib
....e:,'` mode: r
Sworn to and subscribed bale me t "' r�` °, ^' w rPr
this 7 D 20f
Swori .. . : , .._ ... _ -
thi• , Day of f t ` 20 /iv), iJ
—
Notary Public '+otary Public 1 i r /
i et' Revised 01.26.10
DANIEL S. ROMANO
_ . ,;� Notary Public • State of Florida
I 1 .1 11 , My Comm. Expires Nov 12. 2012
4 1, /,' ,,,�;, u•' Commission 0 DD 837063
NOTICE OF COMMENCEMENT
State of Tax Folio No.
County of thin/
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of
the Florida Statutes, the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved:
Address of property being improved: /;A I1t 4// FAG i YoW 3
General description of improvements: R•` Pr
Owner: V. 1( r Address: '17 '3 4) A ,.--(,,„4 f L N , 4.713
Owner's interest in site of the improvement: C",(AAA V rJ
Fee Simple Titleholder (if other than owner):
Name:
Contractor: 8•-oiS
/n e.„
Address: D jC� ,? 1 � hJ �� «,2` -53
Telephone No.: ient C ID -041 PG. Fax No: 'Wt L Yirte
Surety (if any)
Address: Amount of Bond $
Telephone No: Fax No: _
Name and address of any person making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other documents may be
served: Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b), Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement (the expiration date is one (1) year from the date of recording unless a different date is
specified): L31& S-
THIS SPACE FOR RECORDER'S USE ONLY OWNS
Signed:
Date: B s this a o t' 1 in the Cou ikeit,.,2 of 1, State
Doc # 2012027066, OR BK 15844 Page 1969, 3f Florida, has personally appeared
Number Pages 1 'lotary Public at Large State of Florid. • n a .
Recorded 02:08/2012 at 09:51 AM, VIy commis • - • .
JIM FULLER CLERK CIRCUIT COURT DUVAL 'ersonallyI�o , N. • °•. DANIEL S. ROMANO or
COUNTY ?roduced Id �' % Notary Pubik - State of Florida
RECORDING $10.00 1 i My Comm. Expires Nov 12, 2012
`a Commission # DD 837063
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