Permit Roof 885 Amberjack 2012 CITY OF ATLANTIC BEACH
s) 800 SEMINOLE ROAD
ATTLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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Application Number . . .
Property Address 12-00000804 Date 6/28/1212
885 AMBERJACK
LN
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 4900 '
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Application desc
REROOF
------------------ --------------------- --
Owner Contractor
------------------------
---------------------
ST AMAND SIMONE J DAVIIp MERRITT CONST. CO. (ROOF)
885 AMBERJACK LN 108 FLORIDA BLVD
ATLANTIC BEACH FL 322334224 NEPTUNE BEACH FL 32266
(904,) 993-1697
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Permit . . . . . . ROOF PERMIT
Additional desc
Permit Fee . . . . 75 . 00 Plan Check Fee . 00
Issue Date Valuation . . 4900
Expiration Date . . 12/25/12
----------------- -------------------------- --
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 75 . 00 75 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 79 . 00 79 . 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: 9B-5 CW* (ail e. hermit Number:
Legal Description Parcel#
Floor Area of Sq.Ft. Sq Ft
Valuation of Work$ Proposed Work 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
If an existing structure,is a fire sprinkler s stem installed? (Circle one): Yes No N/A
Florida Product Approval # n q.
For multiple products use product approval form �,., (�
Describe in detail the type of work to be performed: k�W 1`
Property Owner Information: ¢QQ
Name: i ne ;5 05
a*i4 Address: 5- �*n bu_rl lQCC- (aA e
City +LAA-H ,seaph State Zip ?22 Phone
E-Mail or Fax# (Optional)
Contractor Information: (1,, ,,,,y
Company Name: C
U/iq_ OA?f Qualifying gis l� 1 &t159NIC4/11 tj
Address: $2 City �J' State r—t�. Zip 3zzy
Office Phone Job Site/Contact Number °I 4 3'-1 l0 9 7 Fax# 2ZA 3 4lv
State Certification/Registration# C'L, (32.59 19
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. 1 certify that no work or installation has commenced prior to the
issuance of a permit and that all work wr11 be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void if wark is not commenced within six(6)months, or if construction or work is suspended or abandonedfor a eriod of six(6)months at any time after
work is commenced. 1 understand that separate permits must be secured for Electrical Work, Plumbing,Signs, Wells, Pools, Furnaces,Boilers,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 here b certify that 1 have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type o1 certify
will be complied with whether sped ied 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 regulating construction or the performance of construction. t
Signature of Owner i f GLt Signature of
g Contractor f✓
Print Name ..) !!I'j.t7 'll .... 1........... ........ ........................................... Print Name 1 Y i?41 ► t e/1�✓l '
Swov�and sub�gribed b ore me Sworn to and subscribed before me
this Day o 20 17 this Day of 20
tart'Public ---------- Notary Public
; ;; :► DAVID E MERRITT
*' MY COMMISSION#DD926677 Revised 01.26.10
- S September 20,203
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NOTICE OF COMMENCEMENT
/
State of � �"'"� _ Tax Folio No.
J
County of (A W
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 sited in this NOTICE OF CO) NCEMENT.
Legal Description of property being improved: ° W.a ti
it
Address of property being improved: ' i 1' t t -. ._ ` -•-L 33
General description of improvements: ' =w
Owner: Sl Mon �J-- 0,rtc, Address.
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: AV t DA 4ZLO
� y� r c" irk � _•. .r y .° r p .�,a
kl,}t`lk Address: 0
`..J gl
! , Telephone No.: "C Fax No: s
Surety(if any) r ,
Address: Amount of Bond$
Telephone 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:
Telephone 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 Statues. (Fill in at Owner's option)
Name:
Address:
Telephone 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 OWNER /
Signed �.;�,u z� -.' .� G� c' ` Date:
,'' —�rds "- in the County Before me this .�� day of �.�� of Duval,State
Doc#2012134164,OR SK•15982 Page 2214, Of Florida,has personally appeared'
Number Pages:1
Recorded 06i28l2012 at 08:37 AM, f"yam.
Notary Public at Large,State of Florida,County of Duval
JIM FULLER CLERK CIRCUIT COURT DUVRL My commission expires:
COUNTY Personally Known: or
RECORDING$10.00 Produced Identification: '.
�'. rr;i�lM1�tSSION#DD926677 J
P),-z-ber 20,2013