Permit Roof 358 Plaza 2012 sir CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00000741 Date 6/12/12
Property Address . . . . . . 358 PLAZA
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 5900
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Application desc
reroof
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Owner Contractor
------------------------ ------------------------
NICKEL CHARLES B. PRO ROOFING & ASSOCIATE
358 PLAZA 25 RUTH DR
ATLANTIC BEACH FL 322335442 PALM COAST FL 32164
(386) 931-0497
-----------------------------------------------,-----------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 80 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 5900
Expiration Date . . 12/09/12
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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 80 . 00 80 . 00 . 00 . 00
Plan Check Total . 00 . 00 ' . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 84 . 00 84 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
09-
CITY OF ATLANTIC BEACH
ROOFING PERMIT APPLICATION
Date: faro �a2/'110-
Job Address: J�S Z� S-� A l/ae 'e XJPdP 1_Z 3.U33
Owner of Property: �NUr/S A/;C A-e
Address: ?J S$ 1/Zo`- S� �'/7�r1 'C ��O�j, �C Telephone: 1W aP 6 16-9'3-7
Roof Contractor: Pio 'Pad"'ne, PAd A550�io7�Qs , State License Number: CCO132 W4
Contractor's Address: l6 752 �t>-Pea*oal fy-,A- •BLwd -,TqeA_-wnJ,-411e, 3aJP5-jg
Telephone: yd`7,' 39y a Q �j Fax: Email:
Scope of Work: 9•I A160Q QICI 901' Qr61 TO"'0 >'CldOJ n Roofing Material /(/✓l2![Q1,6,u✓t
FL Product Approval# fL L179 Valuation of Work:
Required Inspections: Sheathing/In Progress-Dry in /Final
If re-roof: Assessed Value of Structure:_<$300,000/_>$300,000;Roof-to-wall Improvements required?
(Applies to single family structures only)
"WARNING TO OWNER: YOUR FAILURE TO RECORD NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED
ON THE JOB SITE BEFORE THE FIRST M1.
IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECOR=TICE OF COMMENCEMENT"
SIGNATURE OF OWNER: C_/w�� vDate:
AS TO OWNER: _
M
�PMARIA Y.FLORES
Sworn to and subscribed before me this day of J V ri-1 ,20 NZ ,= Notary Public-State of Florida
State of Florida,County of Duval s My Comm.Expires Apr 8,2015
c�
Notary's Signature; -, ,FOFF� •' Commission EE 75158
❑ Per ally known
roduced identification
Typ entification produc d
SIGNATURE F CONTRACTOR: &,71;
Date.
�Z
AS TO CONTRACTOR:
Sworn to and subscribed before me this ' Z day of S�'-`� 20 1 MARIA Y.FLORES
State of Florida,County of Duval „,,,i y
// S€ Notar Public-State of Florida
Notary's Signature: ��t�— Lt- ' ' •'S Comm.Expires Apr 8,2015
OF
❑ Pully known Commission # EE 7558
roduced identification
Type of identification produced
800 Seminole Road•Atlantic Beach,Florida 32233-5445
Telephone: (904)247-5800•Fax:(904)247-5845
F:\roof permit applicaton.docx 7/28/09
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of_ i County of lx)✓c>
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: 3 D UZCA '571"
General description of improvements: ;P>!"16jr/k
Owner Cit w4
Address 35� f��Zz -� /-�f uri •'� B���o�- G 3ca7v233
Owner's interest in site of the improvement
Fee Simple Titleholder(f other than owner)
Name
Address
Contractor a''`rc+c? •' ' ALSO U'cl" S .G.,L .
Address /�'7_SuL (� ✓��;ncrD ��rk _4J✓c l
,-,_i Phone No. 21KY 37!V- �i t Fax No. �Ll%— -3!I
�+�l 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 Lienors 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(1)year from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY
Signed: DATE
Before me this $4. day of --TV K Q_ I Zin the
Coun ,State glori hag personally appeared
1=1 `-'t i 1 herein b
Doc#2012121050,OR BK 15966 Page 741, himsetfl herself and affirms that all statements and declarations herein y
Number Pages:1 are true and accurate
Recorded 06112/2012 at 01:08 PM,
JIM FULLER CLERK CIRCUIT COURT DUV'AL
COUNTY ''>
RIA Y.FLORES
RECORDING$10.00 _
Notary Public at Large,State of o � js-tate of Florida
My commission expires: •
Personally Known �i—L'6nirtfrtXpt Apr 8,2015
Produced Identification •'•'r P' ;` (jpmmiec nn :t E 75158
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