Permit Roof 2303 Fiddlers Ln 2012 CITY OF ATLANTIC BEACH
r ) 800 SEMINOLE ROAD
J ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00000681 Date 6/01/12
Property Address . . . . . . 2303 FIDDLERS LN
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 12775
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Application desc
REROOF
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Owner Contractor
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EBERT WILLIAM P J SCHULTZ ROOFING COMPANY INC
2303 FIDDLERS LAN 216 N. 20TH STREET
ATLANTIC BEACH FL 32233 JAX BEACH FL 32250
(904) 246-2315
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 115 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 12775
Expiration Date . . 11/28/12
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 115 . 00 115 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 119 . 00 119 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
NO'l ICE OF COMMENCE!._ENT
iPREPARE tN DUPLICATE)
Permit No. Tax Folio No. z h
State of Florida County of Duval
To whom It may concern:
The undersigned hereby Informs you that Improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statutes,the following Information is stated In this NOTICE OF
COMMENCEMENT.
Legal description of property being improved:
Address of property being improved: c.�m
General description of improvements: "12 = ,
Owner
Address
r
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor Douglas A.SchuWSchultz Roofing Co.,Inc.CCCO36989
Address 216 N 20th Street Jacksonville Beach,FL 32250
Phone No. Fax No.
Surety(if any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in
Section 713.06(2)(b).Florida Statutes.(Fill in at Owner's option).
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expiration date is one(11 year from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY O NER
Signed: yV� DATE 1--Zr
Doo 201211 222.OR 8K 15951 Page'?163, Before me f 1:, day of x > ' 1 n e
my of t�vej$tate of,Florida,has pars ally appeared
Number Pages 1 f /J r, � t herein by
Recorded 05,22'2012 at 09:43 AM. 1lmsei}!herself and affrms that all statements and deNarations herein
JIM FULLER CLERK CIRCUIT COURT DUV'AL are true and accurate
COUNTY
RECORDING 10 00
k� J �-
Notary Pubile at Large.State of County of .
My commission expires:
Personally Known moi• or
Produced Identiflcati �' _ ROSALIND CLARK
:• MY COMMISSION#EE 001736
't EXPIRES:August 25,2014
BMi09d Thm NutM Public Underwriters
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office(904)247-5826 Fax(904)247-5845
Job Address: s �:7 Permit Number:
Legal Description !!SO /- � � �C � z,�& parcel# /6? r,- -_
Floor Area o
Valuation of Work S 0,-7-S " Proposed Work heated/cooled —no-heated/cooled
Rv roo-,
Class of Work(circle one): New Addition Alteration ..1 Move Demolition pooVspa 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# S44 -R4
For multiple products use product a rove orm /
Describe in detail the type of work to be performed: reR 14 In ke
T ri-v /yl S 300 P-V--/ r` S'Z<r
Property Owner IInformation•
Name: Address: .cl )-z Ai01dle-9� Z.l
City / f� StatC, Zip ja _Aone
E-Mai i or Fax#(Optional)
Contractor Information:
Company Name: Schultz Roofing Co.,Inc. Qualifying Agent: Douglas A. Schultz
Address: 216 N 20t1i St City Jacksonville Beach, Fl. 32250
Office Phone 904-246-2315 Job Site/Contact Number 759-0063 Fax#904-247-3808
State Certification/Registration# CCC036989
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 hermade to obtain a permit to do the work and installations as indicated I certify that no work or installation has commenced prior to the
issuance ion
a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction This permit becomes mdl
and void tfwork is not commenced within six(6)months, or if construction or work is susp ended or abandoned for a rrod of six L6)months at any time after
work is commenced. I understand that separate permits must be secured for ElectricarWork,Plumbing,Signs, Wells,Pools, Furnaces,Boilers,Heaters,
Tanks and A,Con ionen,
rConditioners,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 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, tate, or local da regulating construction or the performance of construction.
Signature of Owner Signature of Contractor
inPltrName (� t I r fl M e r
......................................... 1..e. ....19.... .. ...............................
Sworn to and subscribed re me Sworn to and subscri foreme
this?,:f Day of 20a this /S Day of 20
12
Notary Public HOSALIND CLARK
MY COMMISSION 0 EE 001736 :rlc MY COMMISSION N EE 001736 ql�' : EXPIRES:August 25,2014 �" • ra EXPIRES:August 25,2014
�,p,f, Bonded Thru Notary public underwriters r""�° Bonded Th.NoteryPublic underwriieRised 01.26.10
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