Permit Roof 1842 Hickory Ln 2012 CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
l�
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00000841
Property Address . . . Date 7/05/12
1842 HICKORY LN
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 11400
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Application desc
reroof
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Owner Contractor
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_
DOWLING SHIRLEY M TRUST HAGERTY CONSTRUCTION AND
1 FLEET LANDING BLVD ROOFING
ATLANTIC BEACH FL 32233 3749 QUINBY ISLAND CT
JACKSONVILLE FL 32224
(904) 992-9960
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 110 . 00 Plan Check Fee . 00
Issue Date Valuation 11400
Expiration Date . . 1/01/13
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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 110 . 00 110 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 114 . 00 114 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
NOTICE OF COMMENCEMENT Doc#2012139719, OR 8K 15990 Page 1352,
Number Pages: 'I
Recorded 07/05i2012 at 09:48 AM,
Permit No. JIM FULLER CLERK CIRCUIT COURT DUVAL
Tax Folio No. COUNTY
"' >7 `2 RECORDING$10.00
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property,and in accordance with Se
713.13 of the Florida Statutes,the following information is provided in this NOTICE OF COMMENCEMENT. coon
].Description of property(legal description):
a)Street(job)Address: '� Z' tLaA
2.General description of improvements:
3 Owner Information
a)Name and address:
b)Name and address of fee simile titleholder(if other than owner) !
c)Interest in property
4.Contractor Information
a)Name and address:
b)Telephone No.: Z �,
�.Surety Information Fax No.(Opt.) Z (r
a)Name and address: �Ult, t`f�Z,SCC
b)Amount of Bond:
c)Telephone No.: Fax No.
6.Lender (Opt.)
a)Name and address:
Phone No,
7.Identity of person within the State of Florida desi
grated by owner upon whom notices or other documents may be served.
a)Name and address:
b)Telephone No.:
8.In addition to himself,owner designates the followin Fax No.(Opt.)
713.13(1)(b),Florida Statutes: g person to receive a copy of the Lienor's Notice as provided in Section
a)Name and address:
b)Telephone No.: Fax No.(Opt.)
9.Expiration date of Notice of Commencement(the expiration date is one year from the date of recording unless a different date
is specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART I,SECTION 713.13,
FLORIDA STATUTES,AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB S1 E BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT YOUR LENDER RA ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF"COMME CEMENT.
STATE OF FLORIDA
COUNTY OF PINELLAS1 OX
Si nature f_ r �J
g _Q is Authoriz Officer/Director/Partner/Manager
Print Name
The foregoing instrument was acknowledged before me this_jA�_day of SJ 0&)L ,20 by
as .`�`"\
(type ofauthori
attorney in fact)for name ofparty ' 1��/'
( on behalf of whor f mstt"ire�I ig tg utei�.
Personally Known OR Produced Identification Notary SignaturePel IC.
Type of Identification Produced 11•. .L, Name(print)
7.00 I4t Lk 47. v OR `
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury,I declare that I have read the foregoing and that
the facts stated in it are true to the best of my knowledge and belief
F0RMS/N0C,,sd20I0
Signature of Natural Person Signing(inline#10.)Above
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904)247-5845
Job Address: 18 41 �`}f �(�P,.Y L=63&)r Permit Number:
Legal Description Lbr*?S QjUtr 4' !L-C. t Parcel# +Z�
oor Area o q. 't. Z m Sq.Ft
Valuation of Work 00 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 esiden
If an existing structure,is a fire sprinkler system installed?(Circle one): es�� N/A
Florida Product Approval # 1
For multiple products use product approval form
Describe in detail the type of work to be performed: MEL ) ASS �t��l�QZb�t)r
Tk • ' jr
Property Owner Information: v
Name: U Address:
CityNU jZ.FL14d State Zip _Phone
E-Mail or Fax#(Optional)
Contractor Information:
Company Name:{�N*-,Pft (per, lt) 1. Ppp}yl jj Qualifying Agent: q �./
Address 1jZ City J_!!( 121A i LC State L Zi L
Office Phone _Job Site/Contact Number Fax
State Certification/Registration# LC( V T -jq
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. !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 u construction or work is suspended or abandoned for a period of six(6)months at any time after
work is commenced. !understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools, Furnaces, Boilers, Heaters,
Tanks and Air Conditioners,a C.
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 hereby certify that!have read and examined this plica on and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether spect d ein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other,, eral,stat , or local law r gu ting const n or the performance of construction.
Signature of Owner Signature of Con
Print Name
1.......W...._�.... ..... ........................................ Print Name
Sworn to and subscribed before me Sworn to and subscribe m
b f r 20
this�Day of J Uk) 20 L this ft.( Day of JJ
� lmj�(&A A,� (" I I
�&"a2sn
Notary Public blic
U,00 { � �( , �� L. Revised 01.26.10