Permit Roof 700 Triton Rd 2012 .x I' CITY OF ATLANTIC B
0 EACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
�tit
Application Number . . 12-00000816
Property Address TRITON RD Date 6/29/12
Application type description ROOF PERMIT
Property Zoning TO BE UPDATED
Application-valuation--- ------------4490
Application desc ---------------------
REROOF
----------------------------------------------------------------------------
Owner
Contractor
LOPEZ IRIS M TRUST
5824 REBA ST MANNY' S UNIQUE REMODELING INC
8362 CROSS TIMBERS DR E
MORTON GROVE IL 60053 JACKSONVILLE
FL 32244
_ ------------- (904) 482-9565
Permit ROOF PERMIT -
----------------------------
Additional desc . . REMOVE AND REPLACE SHINGLES
Permit Fee . . . . 75 . 00 Plan Check Fee .
Issue Date . 00
Expiration Date . Valuation . . . . 4490
----------------------------1226/12
----------------------------------------
Other Fees
• • • • . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
--------------------------------
Fee summary Charged Paid Credited Due
----------
Permit Fee Total -------'
75 . 00 75 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 . 00
Grand Total 4 . 00 . 00 . 00
79 . 00 79 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
%–II syr tliL,.ANiIU BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904)247-5826 Fax(904)247-5845
Job Address: 1111-4 -i �� permit Number: /r�
Legal Description Parcel#
Valuation of Work S 0 C�'1 or ea o q, t.
Prroposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/pro osed structure(s)((circle one): Commercial Residen
If an existing structure,is a firs rmkler s s min 1 d?(Circle one): es � N/A
Florida Product Approval # /'-� - p! (
For multiple products use pro uct approva orm
Describe in detail the type of work to be performed: t
Na
Property Owner Information• all �� F, A/eu1 cobra 5 n1i0- two,
Name: '�u1s lU1 • p P e Z Address: -RLb 1L s�-
City AID 2 4t1r� o►� State I L Zipczrs5 3 Phone 8 - 3
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Il 5 ' �"
"� �l'1 Qualifying Agent:�/1/1 �Z_� Z,
Address: C i m Q. �, CityJz�c, or�ut�/� State F
Office Phone Job Site/Contact Number - —Zip .
State Certificatio egistration# Fax#
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address IRIS 1ta 5 / S /ItiO , 6� ��S 3
Bonding Company Name and Address i
Mortgage Lender Name and Address N
Application is hereby made to obtain a permit to do the wo� tstar
and installations as indicated. 1 cert that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to et he ndads of all laws regulating construction in this jurisdiction. This permit becomes null
and void tf work is not commenced within six(b)months, of construction or work is suspended or abandoned for a_period of six(b)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Worly 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 plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type oll work will be complied with whether speci►ed herein or not. The granting of a permit does not presume to give authority to violate o el the
provisions ofarty other federal,state,or local law regulating construction or the performance ofconstruction.
Signature of Owner Signature of Contra for 2
Print Name , l� /� j,.cj Z n
. .......: Print Name h
Swo to,�and subscr'bed before me Sworn t d subs ibed before me
this y of 20 / this ay of
No Public ,
5� f TLC Iwo(�yC t►�"p`� JANIS LARAINE KLICH
!� :4 "*IA t+ CATHERINE P06TILION + a
C00� 1�.� OFFICIAL ms`s ` Notary Public,state of Florida Revised 01.26.10
m�:$�'�
APRIL 21,2014 $ Commission#DD903911
..„�.�.
My comm.expires Juno 30,2013
NOTICE OF COMMENCEMENT Doc#`0121 ss9o9,OR BK lssss Page 827,
Number Pages: 1
Recorded 06/29/2012 at 12:45 PM,
JIM FULLER CLERK CIRCUIT COURT DUVAL
Permit No. COUNTY
Tax Folio No. RECORDING$10.00
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property,and in accordance with Section
713.13 of the Florida Statutes,the following information is provided in this NOTICE OF COMMENCEMENT.
I.Description of property(legal description):
a)Street(job)Address:
2.General description of improvements r_�sf
Owner Information
a)Name and address: 1-5
b)Name and address of ed simple titleholder(if other than owner) hAA `"''Q 1 C- 6 ?5.3
c)Interest in property 0U)it E'
4.Contractor Information
a)Name and address: /{1 � 6►�o�a gJ � C� rmk�
b)Telephone No.: p Z- sem- br-e• ,lc ;oy j N �/
5-Surety Information Fax No.(Opt.) T
a)Name and address:
b)Amount of Bond:
c)Telephone No.:
6.Lender Fax No.(Opt.)
a)Name and address: '
Phone o.
7. Identity of person within the State of Florida designated by owner upon whom noti es or of er documents may be served:
a)Name and address:
co
Oaf'
b)Telephone No.:�[—]�,�,7 —�, ,S- _ � � � 3
8.In addition to himself,owner design tela the f�wmg person to receive a copy
xof the Notice as provided 713.13(1)(b),Florida Statutes: p ed in Section
a)Name and address: Y �o its►,v SOY j. �L?Nn 6)3,Z i
b)Telephone No.: 3a1 5 d- • fYCI, m 4 L jX 3 aqo 3
ar
9.Expiration date of Notice of Commencement(the expiration date is one y afrom he date of recording unless a different date
is specified):
WARNING TO OWNER: ANY PAYMENTS MADE BV THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART 1,SECTION 713.13,
FLORIDA STATUTES,AND CAN RESULT IN YOUR PAVING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY
A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
.
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
STATE OF€6 NtM
COUNTY OF FUE1bg5
10.
Signature of Owner or Owner 0 ntffonzed Officer/D,rector/Partner/Manager
cit M - L -- -E Z-
Print Name
The foregoing instrument was acknowledged before me this
g l day of
r as '20 r s''by
(type of authority,e.g.officer,trustee,
attorney in fact)for
(name of party o biiejialf if whom instrument was executed).
Personally Known OR Produced Identification
Notary Signature !
Type of Identification Produced Name(print) {� Cr.
Verification pursuant to Section 92.525,Florida Statutes. Under penalties of e u I declare th
the facts stated in it are true to the best of my knowledge and belief. p rY, va that
FORMS/NOC,rvsd20I0 ,OFs� , M
11-21 2014
Signature of Natural Person Signing(i i e Bove