Permit Roof 371 3rd St 2012 C � J 0- CITY OF ATLANTIC BEACH
s , 0 800 SEMINOLE ROAD
: J � ' ` "` ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
CM Lf
Application Number 12- 00000386 Date 4/05/12
Property Address 371 3RD ST
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 4698
Application desc
REROOF
Owner Contractor
EILERS ELIZABETH T K & D ROOFING & CONSTRUCTION
369 3RD ST 2758 DAWN RD SUITE 1NE
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32207
(904) 553 -1381
Permit ROOF PERMIT
Additional desc . REROOF
Permit Fee . . . 75.00 Plan Check Fee . .00
Issue Date . . . Valuation . . . . 4698
Expiration Date . 10/02/12
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.
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CITY OF ATLANTIC BEACH
ROOFING PERMIT APPLICATION
Date: 5 - ! — �j /
Job Address: '3 - 7 - 4! r'G/ 5
Owner of Property: i / , 2 of 6 E?' L I le. {
Address: 3 . 3 re S GC-1)) Telephone:
Roof Contractor: �c�c3T ) ✓lc..) irCe,y) s/ State License Number: C - 23
Contractor's Address:. ,z- SSC la. (A V\ ¶ ) . �1 ` / J 9 X 3 ! ` � d C� -
Telephone: re" ?/-. J z // , / 7(Y - Fax: Email:
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Scope of Work: f V�Z�C� R oofing Materi � < � � . (tiS
FL Product Approval # f q , Valuation of Work: $ `7 c-° 7 5y S
Required Inspections: Sheathing /In Progress -Dry in / Final
If re -roof: Assessed Value of Structure: < $300,000/_>$300,000; Roof -to -wall improvements required?
( Applies to single family structures only)
"WARNING TO OWNER: YOUR FAILURE TO RECORD NOTICE OF COMMENCEMENT MAY 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 BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT"
SIGNATURE OF OWNER: — Gyp Date: /aq /L
J
AS TO OWNER: 1--
0 AT AWA.t4YEefet.Etted before me this v day of /4/6c rc--'\ , 20 JD•—a
State of Florida, County of Duval g
Notary Public, State of Ohio Notary's Si natur :
Personally known
My Commission Expires Sept 13. 2014 0 Produced identification
Type of identification produced
SIGNATURE OF CONTRACTOR: Date: 3 — — h+
AS TO CONTRACTOR: �y /n �f
Sworn to and subscribed before me this / day of L' /Gi!. h a , 20 l
State of Florida, County of Duval � —�
Notary's Signatur : ► >re Xy�J
OATHA A. DEUBLER Rersonally known
0 Produced identification
Notary Public, State of Ohio Type of identification produced
My Commission Expires Sept 13. 2014 800 Seminole Road • Atlantic Beach, Florida 32233 -5445
Telephone: (904) 247 -5800 Fax: (904) 247 -5845
F: \roof permit applicaton 2010
NOTICE OF COMMENCEMENT
State of Florida. County of nu'•ni
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 availabie t:
J L1 j r S /_ i Iysi t % - i3)(:�� 1 L- '-? J -s-.:j
r a n: , r7 ., f ;m verments: /
� le.CCO U.St n3 3h iPS •
3. Owner information: .1
" '�aitte ana Address: �_-/
' , / I
Z ) — /---; / ` I
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(-5 ' 3 l C 5 � /l /l c 7 1� i c. r - �t'•�. t
b) Interest in property:
c) Name and address of simple titleholder (if other than owner): -.) 3 3
4. Contractor Information:
a) Name and Address: K t n }OC n( a156 1a.W n Rd Sit i Oa x , �-! .aDO
N
b) Phone umber. q 0' ` 4l- 1 700
5. Surety Information:
=) Name and Address:
b) Phone Number:
.) Amount of Bond: S
6. Lender Information:
a) Name and Address:
b) Phone Number.
7. Person xvithin 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:
-r b) Phone Numbers of Designated Person:
c
C7i
0 8. In addition to himself/herself, Owner designates of to receive
rn E- a copy of the Lienor's Notice as provided in Section 713.13 (1) (b), Florida Statutes.
CL • ce a) Name and Address:
e , 2 - O
b) Phone Number of person or entity designated by owner:
R a. 1- 9 Expiration date of Notice of Commencement (The expiration date is one (1) year from the date of Recording unless a
r 5 different date is specified:
Y ofr
tr m U WARNING TO OWNER ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
O N Y 0 NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART
L 6 W o 1, SECTION 713.13 FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
v w 6 v ig IMPROVEMENT'S TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
o rn v or 0 POSTED ON THE JOB SITE BEFORE THE FIRST NSPECTION. IF YOU INTEND TO OBTAIN FINANCING,
N a } o CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING
p a u_ z YOI T OTICE OF COMMENCEMENT.
b D J., -- OA
Signature of Owner or Owner's Authorized Officer /Director /Partner/Manager Signatory' a Printed Name & Title/Office
The foregoing instrument was acknowledged before me this+ V� 1 d of 1 ), r" C I\ , 20 i - , by
fi
as for -
t A L W� of Person) (Authority Type, i.e. Officer/Attorney) (Name of Party Instrument was Executed for)
c ` Mil P e S of Ohio NOTARY PUBLIC. STATE OF FLORIDA
_ Print Name: .../4-i,--,_ Ve- Ako_ i
' MV Ceram Nh0nn Ert01 Sept 13, 2014
_ Id ers ' onally Known It
< , l ' ' ` �� � . en fi cation/T'ype: l k
j 0T Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read the J ) i '
t : foregoing and that the facts stated in it are true to the best of my knowledge and belief
F,,.
i
Signature of Natural Person Signing Abovc
Revised 10/1/2009 i
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