Permit Roof 1768 Park Terr W 2012 ' CITY OF ATLANTIC BENCH
800 SEMINOLE ROAD
= ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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Application Number . . . . . 12-00000708 Date6/06/12
Property Address . . . . . . 1768 W PARK TER
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 12600
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Application desc
reroof fl 183 . 9
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Owner Contractor
LANIER MICHAEL W K & D ROOFING & CONSTRUCTION
1768 PARK TER W 2758 DAWN RD SUITE INE
ATLANTIC BEACH FL 322335612 JACKSONVILLE FL 32207
(904) 553-1381
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 115 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . 12600
Expiration Date . . 12/03/12
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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.
Ani
BUILDING PERMIT APPLICATION
CITY OF A'T'LANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office(904)/247-5826 Fax(904) 247-584_
lt< � �
Job Address: c Permit Number:
Legal Description Parcel
nor Area of Sq.rt. S t
Valuation of Work S�� Proposed Wort: heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) circle one): Commercial Residential
If an existing structure,is a fires n iter s stem installed?(Circle one): Yes No N/A
Florida Product A proval# / E 3
For multiple products use product approva orm _
Describe in detail the type of-work to be performed: to
Property Owner Information:
Name: *`2 Address:
City StateV-- Zip_ hone S'tl/ C)
E-Mail or Fax#(Optional)
Contractor Information: t /
Company Name: QualjLymg Agent:
Address:a 4-6 K Ma cdN City State _ ZIP _
Office Phone 4//— d Job Site/Contact Number Fax#
State Certification/Registration
Architect Name&Phone#
Engineer's Name&Phone# -�
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
.4pplication is hereby made 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 of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. R s 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 sir(6)months at arty time after
work is commenced I understand that separate permits must be secured far Electrical Work,Plumbinb Signs, Wells,Pools,Furnacev,Aoilers,Heaters,
Tanks and Air Conditioners,eta
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR BIPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULTWITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOVii 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 o work will be complied with whether specie ed herein or not. The granting of a permit does not presume to give authority to i�olale'or cancel rhe
provisions of arty other federal,state, or local law regulating construction or the performance of construction.
Signature of Owner- Signature of Contractor
Print Name ...1_11 ,'�:.. ...�-...1�{t L/Z Print Name ° ..a.. .. ...C.... ............�.../...�.. .1lip
S-Z, u�sqbi -d before me Swp- bibd before;tee
tof 4� this Day of:�' �TotaPublic
QA THA
A. DEUBLER Revised 01.26.110
Notary public, DATHA A. DEUBLER
State of 7hlp
"1V Cerpmisslon Seat 13,201q i x Notary Public, State`of Ohio
Hires
My Commission Expires sent 13 20,,4
NOTICE OF COMMENCEMENT
State of Florida.County of rhnal
TRE UNDERSIGNED hm-eby give notice that the improvement will be made m certain teal property in accordance write
Chapter 713,Fbrir�Statutes,the following information is provided in this Notice of Com►rtenropert t
1• Descrip"on ofpro _ (lege!descrip"on of o
2perty and address if avai a is
-'�:=tCrL4rCc�R•:!ft!!IhrPve!Tlettt5:
r: 5
. -� u l 5�i ry,SPC '
3, Vwnerinformation:
ame ana.address:
r
,Y
b)Interest in properly: ,
c)Name and address of simple titleholder(if other taan owners:
4- Contractor Information:
a)Name arra^ddress
b)Phone Number�C � 6 7
5. Surety Information:
s.)Varne and Address:
b)Phone Number_
O Amount of Bond:S
6. Lender Information:
a)Name and Address:
b)Phone Number.
7- Person"ilthm tate State of Florida designated by on ner upon whom notices or other documents may b`A
Provided by 713.13(1)(a)7,Florida Statutes: served as
a)Name and Address-
b)Phone Numbers of Designated Person:
8. In addition to himselVberself,Owner designates a
a copy of the Uenor's Notice as provided in Section 713.I3 1 of to receive �� D
a)Name and Address: ( )(b)>Florida Statutes. o
b)Phone Number of person or entity designated by owner a
9 Expiration date of Notice of Commencement(Thc expiration date is one l rn a v0
different date is specified: ( )year from tare date of Recording unless a
V)
'VAR1oTING TO OWNER: ANY PAYMENTS MADE BY THE OWNER A °Y° U
NOTICE OF COMMENC AFTER THE EXPIRATION 3, THE 0 iv v
EMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER?13,PART Y o
!Mi'ROVEMENTS
1, SECTION 71� FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR o
TO YOUR PROPERTY.A NOTICE OF COMMENCEMENT MUST BE RECORDED AND --(6,
POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION.IF YOU INTEND TO OBTAIN FINANCING, �.� 00"b
o tr
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE CONMENCI2vG WORK OR RECORDING
T W
YO OTICE OF CO_�IMENCE,\IE .
a #d Z O
' G INP4 L falU I 6i� o E Q�O w
SS store of O, Owner's Authorized Officer/DirectorlParmer/�rlana er Si aro
8 gn ry's Printed Name$Title/Office
The foregoing instrument was acknowledged before me this da o f 20 I v
(Name of Person) as for
(Authority Type,i.e.()Mc /;A�ttomey) {Name of Party insnvment was&xeCuted 1
►J '
Ug .X-
rMUeLER NOTARI'PUBLIC.STATFF
No
f Stat Print Name:
a of Ohio i_^�
�Afilal P y Known
+tl'13.201q -IdentificationlType:
r
�, . /A prsuanf 20 Section 92.525,Florida Statutes.Under penalties of perjury,I declare that I have read the
facts stated in it are true to the best of my knowledge and belief
rr� Signature of Natural Person Signing Above
Revised 10/1/2009
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