Permit Roof 368 7th St 2012 C ►xAI
r) Orp 111
CITY OF ATLANTIC BEACH
s) 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
, Ji3
Application Number 12- 00000439 Date 4/16/12
Property Address 368 7TH ST
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 2000
Application desc
REROOF
Owner Contractor
LINDLEY TOLBERT DESIGN INC JUSTIN LARSEN CONSTRUCTION INC
465 BEACH AVENUE PO BOX 1942
ATLANTIC BEACH FL 32233 4784 CATTAIL ST
MIDDLEBURG FL 32068
(904) 241 -0320
Permit ROOF PERMIT
Additional desc . REROOF
Permit Fee . . . 60.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 2000
Expiration Date . 10/13/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 60.00 60.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 64.00 64.00 .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: 3‘g 7 c%l Permit Number:
Legal Description 5.'-` O N Z - 2 V c Parcel #
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ c.2/‹. Proposed Work heated /cooled non- 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 # _rL.. 70 0 (o — v
For multiple products use product approval form / ,
i
Describe in detail the type of work t be perform: I : A .s ar /� ,, `4Ll/
!� A I, ,G-( / i� �_ _ � /���
Property Owner Informatiw /
Name: /� � %iI /7 Address: /3 e /f }lye
City /d /e. b i4'T1` r 8&Pt ✓ ✓ '
Statq; L Zip � Z 233 Phone 90 f - 039-
E -Mail or Fax # (Optional)
Contractor Information:
Company Na e: u ,•� C.Irv3t cn
Qualifyi e t
Address: ' 7 b ''PTA `L S ' City WI t v Al
� � :
1 State F C Zip
Office Phone
Job Site/ Contact Number Fax #
State Certification/Registration # CCC 13 Z 9 Ei 97
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 zf work is not commenced within six (6) months, or if construction or work is suspended or abandoned for aperiod 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 s.eci zed herein or not. The •ranting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal, state, or loc' ,- w regulati , • onstructiof the performance of construction.
Signature of Owner . Signature of Contractor
Print Name . e T 1 6 e A/ ' Print Name JO $1 Li
Sworn to and subscr b fore me Sworn to and subscribed before me
this /( Day of r'r , 20 / Z this /6 Day of /p—// 2,0
0 ✓ . �,r Q G ,, WILLIAM L'POT'C Z
i _0 Notary Public, State of Florida
Notary Public WILLIAM L POPE
N otary Pu. T y Drum, 1 : . •
Notary Public, State of Florida Commission No. EE 128745
My Comm, Expires Oct. 19, 2015 Revised 01.26.10
Commission No. EE 128745