Permit Roof 1047 Hibiscus 2012 41, CITY OF ATLANTIC BEACH
.. i 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000328 Date 3/22/12
Property Address 1047 HIBISCUS ST
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 5270
Application desc
reroof
Owner Contractor
KELLEY DARLENE F EXCEL ROOFING CONTRACTING
1047 HIBISCUS ST 2368 SANDY RUN DR N
ATLANTIC BEACH FL 322332651 MIDDLEBURG FL 32068
(904) 463 -3438
Permit ROOF PERMIT
Additional desc . .00
Permit Fee . . . 80.00 Plan Check Fee .
Issue Date . . . Valuation . . . . 5270
Expiration Date . 9/18/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 80.00 80.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 84.00 84.00 .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: 0 fl '1 1 - ) i 13 (5 d o S Permit Number:
Legal Description 3t 4i4- ! Pi-/CB L or I4 Parcel # 1 1 -III0)
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ 6 Proposed Work heated /cooled non - heated /cooled
Class of Work (circle one): New Addition Qlteratiory' Repair Move Demolition pool /spa window /door
Use of existing /proposed structure(s) (circle one): Commercial 4'
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes To) N /A
Florida Product Approval # FL 10 I —'-(• / (°
For multiple products use product approval form
Describe in detail the type of work to be performed: .i C Rine c F 6/1. 1 n 6 I
Property Owner Information:
Name: J J 11- RL Address: / 7 tt //3/6&:)6 57 -
City ` t /lr r 7itc. 1 3 E - & StateELZip 31x33 Phone 4 T 7 - (nfa
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: ez O EL /tC/lI N 6 ()Ott rear Qualifying Agent: 5 Tr 5 4(e,1
Address: ")toed 5 K0Y /c,r.t /O/L 14 City VIA K1 oLt`76vt State f - Zip 3 0
Office Phone 4t { - 43 ( -766 3 Job Site/ Contact Number 1'04-63/ -7463 Fax # ?D'/ - X 1q 'may
State Certification/Registration # C.CC. ( 3 AS ( ro
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 a period of six (6) months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, 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 I have read and examined this a placation 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 uthor '. o violate or cancel the
provisions of any other federal. state, or local law regulating construction or the performance of construction.
Signature of Owner X Signature of ContractorX
Print Name Z.,Rfii �. 4aly Print Name fj'] 2-y Sd Sworn t ant_. bsoribid befo m Sworn to and subse*i 4rkrre
this -et ay o r 1'1 , ,r, 20 this Z_ ►.y ti !riftcommilffirti:m 20 2- j t mi Nota • . � f;, HIRLEN L GRAHAM I • L. GRAHAM '� A D D 9 57760
My OMMiSSiON d DD 957760 I • " EXPIRES: - .ruar t�yp 11.26.10
- ` EXPIRES: February 14, 2014 L �•'
g �o a, Bonded Thru Notary Public Underwriters " -- Bonded Thar Notary Public UdhrwrMers
MAR -22 -2012 14:44 FROM: CLERK OF COURTS 904 270 1512 TO:92475845 P:1/1
NOTICE OF COMMENCEMENT
Permit No. f -- CCU 3afr Tax Folio No. i71ovgs -O o?,
State of Florida. County of Duval
THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with
Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement.
1. Description of property (legal description of property and address if available):
l cN fi 13tx Lest /' -3 ? -- `s' - . a. 5 " 246
2, General Description of improvements:
tee - aQo �
3. Owner Information:
a ) Namc and Address: g6, K eu
b) Interest in property: i434? Pit RF,e< FL--
c) Naive and address of simple titleholder (if other than owner):
4, Contractor information: a) Name and Address: ' cfl - 5f,, , P 01 4EK a- 344 3 xt Aire /dc.n Zia. 4. not [01966 P4
b) Phone Number: 104 -
, Surety Information:
a) Name and Address: 1
b) Phone Number: _ k ,�
c) Amount of Bond: $ / f'
6. Lender Information:
a) Name and Address:
b) Phone Number:
7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13 (1)(a) 7, Florida Statutes:
a) Name and Address: �.
b) phone Numbers of Designated Person:
S. In addition to himself /herself, Owner designates of _ to receive
a copy of the Lienor's Notice as provided in Section 713.1 (1) (b), Florida Statutes.
a) Name and Address:
b) Phone Number of person or entity designated by o .. er: _
9 Expiration date of Notice of Commencement (The expiration date is one (1) year from the date of Recording unless a
different date is specified:
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART ,
1. SECTION 713.13, FLORIDA STATUTES. AND CAN RESULT IN YOUR PAYING TWICE FOR.
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU .INTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY I3EFORE COMMENCING WORK OR. RECORDING
YOUR NOTICE OF COMMENCEMENT.
The foregoing instrument was acknowledged before me this a day of 04 ?V& 2O/
I]oc # 2012063023, OR 8K 15888 Page 1 811, 1‹,
Number Pages: 1 NOTARY PI. BL ?C, STATE _ FLORIDA •
n'3•C,d PM - -