Permit Roof 1175 Seminole Rd 2012 C ^tSf 't,..›
N ; af CITY OF ATLANTIC BEACH
s) 800 SEMINOLE ROAD
'� - , XI ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
C '
J i3 SW
Application Number 12- 00000610 Date 5/18/12
Property Address 1175 SEMINOLE RD
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 1600
Application desc
ROOF REPAIR
Owner Contractor
NAUMANN ANNELIESE LIFE ESTATE TED SIKES ROOFING LLC
% KEITH NAUMANN 3420 UNIVERSITY BLVD STE 101
908 PRINCE PHILLIP DR JACKSONVILLE FL 32216
VIRGINIA BEACH VA 23452
Permit ROOF PERMIT
Additional desc .
Permit Fee . . . 60.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 1600
Expiration Date . 11/14/12
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: J 1 7 6 _ 1;r / tie C&- RAD Permit Number:
Legal Description Parcel #
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ /4, ,,, Qa Proposed Work heated /cooled non - heated /cooled
Class of Work (circle one): New Addition Alteration ' epair Move Demolition pool/spa window /door
Use of existing/proposed structure(s) (circle one): Commercial : • sidentia
If an existing structure, is a fire sprinkler system installed? (Circle one): • es No
Florida Product Approval #
For multiple products use product approval form
Describe in detail the type of work to be performedTe Pi41 R,, bA-0444 4ios 4,-YD
u11: :4 , 4 L 6∎_.. it O = . / , i .
Propert y Owner Information:
Name: t k- NCNOOLLAVV :k h in Address: `L 1 5 Se vyn on.b�'2 Oci
City i■Tl A•N 1 tL ? P.t..4 State &ZipSZ233 Phone `Z +SZ ' 4'31 eo 33
E -Mail or Fax # (Optional) . a q - - wiz:
Contractor Information: /
Company Name: reo S-Z Kt S �� O t -ek?2{ Qualifying Agent: 7 p o, 104 t._..4 . 51/
Address: 7!?t` a i•a ire Ao r t .
City acicKSa>'rvll State Pit Zip P.a.l'
Office Phone 3'f' wo. Job Site/ Contact Number 'yam --dr23 Fax #
State Certification/Registration # /ZC e Z9
Architect Name & Phone #
"N Engineer's Name & Phone #
Fee Simple Title Holder Name and Address
Bonding Company Name and Address / P
Mortgage Lender Name and Address j
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 if work is not commenced within six (6) months, or if construction or work is suspended a_ ended or abandoned for period of six (6) months at any time after
work is commenced. 1 understand that separate permits must be secured for Electrical Plumbing, Signs, Wells, Pools, F urnaces, Bo 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.
1 hereby certify that I have read and examined thisplication 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 sseci zed 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 , regulating construction or the performance of construction.
Signature of • _ * V 4 P . y� ,�r Signature � � ,, Si of Contractor 47 4 t9
Print Name `� �, l h C , 0 �L(�,�` p RY N!�LC'p int Name l h Q 71 t7 /' e ! � C° s
Swo t and subscribed before me 2 : PUBLIC � �
+ -EG # 7189 , orr to subscribed be ore me
this _ Day of 0 1 :- , O MMISSION ? i iif / �( Day 'f f / 9 , 20 `,
Ai • � EXPIRES + 0 • \` - 1'
Notary Public :, p ,. Jw otary Pu is , . p
,. � rr •• 1 ,
.1 ,.• • EE 018593
N Ap r r 30, 2014
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