Permit Roof 1921 Selva Marina Dr 2012 0
''} CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
, ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 12- 00000557 Date 5/08/12
Property Address 1921 SELVA MARINA DR
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 1800
Application desc
SHINGLE NEW CONSTRUCTION
Owner Contractor
WARFLE, DAYTON F JR SCHULTZ ROOFING COMPANY INC
1921 SELVA MARINA DR 216 N. 20TH STREET
ATLANTIC BEACH FL 322334519 JAX BEACH FL 32250
(904) 246 -2315
Permit ROOF PERMIT
Additional desc .
Permit Fee 60.00 Plan Check Fee . .00
Issue Date Valuation . . . . 1800
Expiration Date . . 11/04/12
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
rr� O _ �� Office (904) 247 -5826 Fax (904) 247 -5845
Job Address: ' , `– 4 Jj ' i A
Permit Number:
Legal Description 1
., Li 4 I . o' e Parcel # c
Valuation of Work $ - g > oo ' ea o q. t.
aka. Proposed Work heated/cooled t
n on - heated /cooled
Class of Work (circle one): CIO . ddition Alteration Repair Move Demolition
Use of existing/proposed oUspa window /door
g/pro osed structures) (circle one): Commercial Residential
If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No N /A
Florida Product Approval # FL. S(.
For multiple products use product approve.--In
Describe in detail the type of work to be performed: -2-tvs iAl/ A nn/<o 3
Ne. _ S L Tiq�.. �`�` S /e o
Pray Owner Information:
Name: t . , 4 J.:
City
Name:
ib Address:
E -Mail or Fax # StateA7Zip "�- __P i ��G
(Optional)
Contractor Information:
Company Name: Schultz Roofing Co., Inc. Qualifying Agent: Douglas A. Schultz
Address: 216 N 20 St City Jacksonville Beach, Fl. 32250
Office Phone 904 - 246 -2315 Job Site/ Contact Number 759 -0063 Fax # 904 - 247 -3808
State Certification/Registration # CCC 6989
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 cert5 that no work or installation has commenced
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 sus ended 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 Electrica - Work, Plumbing, Signs, Wells, Pools, F urnaces, Boilers, Furnaces,
Tanks and Air Conditioners, etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEME
TO YOUR PROPERTY. IF YOU INTENT) TO OBTAIN FINANCING CONSUL NTS
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE WIT
COMMENCEMENT.
1 hereby certify that I 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 spec: red herein or not. The granting of a permit does not presume to give arrthori ty to violate or cancel the
provisions of arty other federal, state, or local law regulating construct or the performance of construction.
Signature of Owner `----
p r , ,, T Signature of Contractor '
inPltlh#ame
Sworn and subscri - • ` . .. '. ..•' c �'..t.i ,
this Day of r t for;m i 20 Sworn t sub.„ • ' .: - d before me
t _ � this ba o I�
/
Notary Public : "! ;•MM ISSION a -� r � — �� " c _ / �,►
.aL, EE 001736 1 otary * :: �, + ' - ALIND CLARK
-'o EXPIRES: August 25, 2014 *, MY C
a pt p;` Bonded Thru Noteryp Underwriters n ; , COMMISSION a EE Ooi736
ii;? Bonded EXPIRES: p
"%gy p ,}t`: Rini Notary Public Underwriters 1. 26.10
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