Permit Roof 1934 W Sevilla 2012 4 t.0 CITY OF ATLANTIC BEACH
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S IZ
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) 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
.,, INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000468 Date 4/20/12
Property Address 1934 W SEVILLA BLVD
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 10940
Owner Contractor
WITHERIDGE, JOYSE TRUST HANSON ROOFING INC
JOYSE WITHERIDGE TRUSTEE 2714 CORTEZ RD
1934 W SEVILLA BLVD JACKSONVILLE FL 32246
ATLANTIC BEACH FL 322334578 (904) 641 -6328
Permit ROOF PERMIT
Additional desc . REROOF FL10124 -R6
Permit Fee . . . 105.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 10940
Expiration Date . 10/17/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 105.00 105.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 109.00 109.00 .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: 1 5c- Vi t i c, . L vet (, j - Permit
Number:
X Legal Description its 7 or---/- s S',E,,), 71 a. o. Parcel
# l 96 z o 935 _
Floor Area of Sq.Ft.
Sq.Ft o
Valuation of Work $ /0 9 9 Proposed Work heated /cooled non -
heated /cooled
Class of Work (circle one): New Addition lteratio Repair Move Demolition
pool /spa window /door
Use of existing /proposed structure(s) (circle one): Commercial e�id 'nti l�l
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval # R lr oi 2,G,
For multiple products use product approval form
Ns in detail the type of work to be performed:_
KA jT s(n4 94. . -0'0 6 In.e
Property Owner Information: // rr
Name: Ty c� tom,, rt `d f e Address: 1 93 3e141/0- ��v of Li City � Q Stater/ Zip , Z. 2,33 Phone 9 q .Z W - 3
E -Mail or Fax # (Optional)
Contractor Information:
Company Name: pt.c iy lacsei C6 T- - Qualifying Agent: �' ;-�ib• /
Address: 4 971 y L,,c - #,L k iJ Ci
Zip Z q I h Jc< <GCS�h ur l State
Office Phone 7 041- WO -1•32.y Job Site / Contact Number 90t1 - 533 - 9oGk Fax # 90Y- 641 -G0;5z y
State Certification /Registration # '�. 4.S 'if
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 certiji 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. 1
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 certiji that I have read and examined this application 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 local law regulating construction
or the performance of construction.
Signature of Owner _, Print Name g- v' e to , 44 I / e t cot
r_
to and subscribed before / q
this / q ./ ✓
Day of !,,
me
20 .1.—` _ _ '� _ _ _
�� �' I ; � JEANNETTE M. NIELSEN I
/,! n4 ,; . ,.& , .0 _ _ I "11 o r Notary Public - State of Florida 1
No Public 1
:• 6 ' . My Comm. Expires Jun 30, 2014 '
•
+ Commission 0 DD 989725
1 %•0
`' Bonded"'r��� ' Through National Notary Assn. 0
Signature of Contractor AA /(_
Print Name
Sworn to nd subscri. -d before me
this/ 9 ill D of ,.___,I___ ' A 20 i 1 )11-
44 Notary P is
V J EANNETTE M. NIELSEN
- Notary Public - State of Florida
a My Comm. Expires Jun 30, 2014
'--,--.
Commission 0 DO 989725
Bonded Through National Notary Assn.
Doc # 2012087196, OR BK 15919 Page 2179, Number Pages: 1, Recorded
04/20/2012 at 02:53 PM, JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY RECORDING
$10.00
•
NOTICE OF COMMENCEMENT
Permit No.
Tax Folio No.
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Section
713.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT.
t` I .Description of property (legal den' rl lion): 1 /5" - 7 t, Y -�6 —;1..9 6 �, // _ C►a�Ci�rr, (/ d i� �
a) Street (Job) Address: / $3 Li 5 � ( (�t- y d L �
2.General description of improvements: i`, t� �'C e ��. Z733
X 3:Owner Information
a) Name and address: o �, . �y , . e4/' t3
b) Name and address of - simple titleholder (• other than owner)
c) Interest in property R 1 I
4.Contractor Information 14 •
a) Name and addressp:, 1 4 ti b „L
b) Telephone No.: l 0 1t - 333 - 1b(o`( Fax No. (Opt.) 4O4 - z. -
5.Surety information
a) Name and address: A/ /4
b) Amount of Bond:
c) Telephone No.: Fax No. (Opt.)
6.Lender
a) Name and address:
Phone No.
7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a) Name and address:
b) Telephone No.: Fax No. (Opt.)
8.1n addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes:
a) Name and address:
b) Telephone No.: Fax No. (Opt.)
9.Expiration date of Notice of Commencement (the expiration date is one 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 YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
STATE OF FLORIDA
•
COUNTY OF PINELLAS 1
444 r • caner or w/In.e1r� er/Director/Partner /Manager
k ro te .me Y L T / 1`•
The foregoing instrument was acknowledged before me this / 9' day of` ,20, b
Y
as
(type of authority, e.g. officer, trustee,
attorney in fact) for
(name of party on behalf of whom i , strumen was exec ed).
Personally Known 42_ OR Produced Identification _ Notary Signature i SA
Type of Identification Produced Name (print) `, J
OR -">< -
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of Perjury,1 declare that I have read the foregoing and that
the facts stated in it • = • . 1- • - t • m knowledge and belief.
,a„1Y2 •,,,,
JEANNETTE M. NIELSEN
FORMSMOC.nsd2010 �' 4) . Notary Public State of Florida
My Comm. Expires Jun 30, 2014 Signature of Natural Person Signing On line # 10.) Above
4, 1 Commission 0 DD 989725
"' Bonded Through National Notary Assn.