1220 Seminole 2012 - Roof Repair Permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
° = ATLANTIC BEACH, FL 32233
INSPECiTION PHONE LINE 247-5814
Application Number . . . . . 12-00000710 Date 6/13/12
Property Address . . . . . . 1220 SEMINOLE RD
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 1350
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Application desc
reroof
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Owner Contractor
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ELF, ROBERT D. TRUST SCHULTZ ROOFING COMPANY INC
1220 SEMINOLE ROAD 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 . . . . 60 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 1350
Expiration Date . . 12/10/12
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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 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
w 800 Seminole Road, Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904) 247-5845
Job Address: ,% � �, 110 e5 1 P_ (Jl. Permit Number:
Legal Description Parcel#
Floor Area of Sa.Ft. Sq. t
Valuation of Work$ 13SO Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration epa> Move Demolition pool/spa window/door
Use of existing/pro osed structure(s)(circle one):installed?
Residential
If an existing structure,is a fire sprinkler system nstalled?(Circle one): Yes No N/A
Florida Product Approval#qy$ - RQ-
For multiple products use pro uct approve orm
Describe in detail the type of work to be performed: Pepe fr 7b F(.A'r {took reroy O Pt^^Q Hw-,q-
Provertv Owner Information:
Name: - Address: -9,40
City StateZip� � Phone
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Schultz Roofing Co.,Inc. Qualifying Agent: Douglas A. Schultz
Address: 216 N 20'h 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 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. This permit becomes null
and void tf work is not commenced within six(6)months, or if construction or work is suspended or abandoned for aperiod of six i)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools,t urnaces,Boilers,Heaters,
Tanks and Air Conditioners,eta
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 thisplication 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 speci ted 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 law re Latin construction or the performance of construction.
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Signature of Owner ature of Contractor
inl'llr3ame ntYee
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vfl �...... :.... � ..c ,...........................................
Sworn to and subsc ' d before me Sworn to and subs ri ed before me
this �ff_Day of 2047 this -!5;-Day of 20
,/Notary Pu _ MY COMMISSION—#EE 001736 le LARK
; Q EXPIRES:August 25,2014 :•_ MY COMMISSION#EE 001736
;of °. Bonded ThN Notary Public Undenrrtfters EXPIRES:August 25,2014 IZ ised 0l.26.10
•aF Bonded Thru Notary Public underwriters