Permit Roof 335 Ahern 2012 p. .
CITY OF ATLANTIC BEACH
J - :tr 0 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000532
Property Address Date 5/03/12
T
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 7500
Application desc
ROOF REPAIR
Owner Contractor
BTMJS LLC K & G CONSTRUCTION CO INC
1635 EAGLE HARBOR PKWY SUITE 4 2180 AARON DRIVE
ORANGE PARK FL 32003 GREEN COVE SPRINGS FL 32043
(904) 509 -8888
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 90.00 Plan Check Fee .00
Issue Date Valuation 7500
Expiration Date . . 10/30/12
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 90.00 90.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 94.00 94.00 .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: 135 A� �,, S A k\ A� l,'c �eco1 Z)
�
P ermit Number:
Legal Description
�G oor • ea o Parcel #
Valuation of Work $ �/ C Proposed Work heated /cooled t
non- heated /cooled
Class of Work (circle one): New Addition Alteration Repair ove Demolition pool /spa window /door
Use of existing /proposed structure(s) (circle one): Commercial
If an existing structure, is a fire sprinkler system installed? (Circle one): ide nti N /A
Florida Product Approval #
For multiple products use prod pt acu proval form
Describe in detail the type of work to be performed: - p -,,�
s
Property Owner Information•
Name: QT l L �
Address: l6 Z S g t a � j � P , s
City FI, „, , �S (r I a�i Stated Zip Phone
E -Mail or Fax # (Optional) -� 4 Z ► y- 'l Sf
Contractor Information:
Company Name: IA �- & Cc_ , S T/f�Gf !
Address: Z -a Qualifying Agent:
,. rc
Office Phone qo�-i- Soy kg.�� City _/", r QQ..c C � ' `State
Job Site/ Contact Number - Fax Zip o y
State Certifieation/Registration # c ce `io`r o- 2 old Fax # q y_ 6 L _ q 3
z- `l
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 cert 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 pernfit becomes null
and void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a verfod of six (6) months at anv time of er
work is commenced. / understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Healers,
Tanks and Air Conditioners, etc
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEME TS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
1 herebv 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 complied with whether sppeci fed herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions ofany other federal, state, or local tnv regulating construction or the performance ofconstruction.
Signature of Owne_
Signature of Contractor
Print Name Jar . / Jh ;
Print Name n �14.i2, C�
Sworn o and sub . - d` me
this Da `f II/ , r Karen T Hi. inbotham 20 Sworn to and . u. .. • me
this _L a 1 , ' otary Public, State of F on +a of %J4 20 -
Notary pub 99mbotham
Commission No, DD 922164 ` +tary �i:',. '
;,,:,;�'� L commission Expires 9.2.2013
Commis�� ��1 0