Permit Roof 495 Aquatic Dr 2012 CITY OF ATLANTIC BEACH
s) 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
e.�. INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00000830 Date 7/02/12
Property Address . . . . . . 495 AQUATIC DR
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 3575
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Application desc
REROOF
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Owner Contractor
------------------------ ------------------------
CLIFFORD REBECCA C BETTER HOME IMPROVEMENT (ROOF)
495 AQUATIC DRIVE 538 PARK AVE
ATLANTIC BEACH FL 322333837 ORANGE PARK FL 32073
(904) 278-0810
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Permit . . . . . . ROOF PERMIT
Additional desc . . REROOF
Permit Fee . . . . 70 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 3575
Expiration Date . . 12/29/12
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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 70 . 00 70 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 74 . 00 74 . 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: ,V1 erm•t Number:
Legal Description w c_(WAdi
arcel# 3f
—F oor Area o q- Ft. q.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 structures)(circle one): Commercial esiden
If an existing structure, is a fire sprinkler system installed?(Circle one): es N/A
Florida Product Approval# Fc,- '� L( , -2
For multiple products use promo uct approve form
Describe in detail the type of work to be performed: k-a,"
Property Owner Information: /
Name: Address:
Cts- State"Zip_-A
E-MFax f(Optional) S
Contractor Information:
Company Name: d Qualifying Agent: lAt
Address: City pt cxn G-_State 1.-�-- Zip
Office Phone Job Site/Contact Number�,)._ rax# a- I
State Certificati egistration#_ C C G (6 a 7;9 G _
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 if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a_period of six6)months at any time after
work is commenced. 1 understand that separate permits must be secured for Electrical Work, Plumbing,Signs, wells,Pools, 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 YOVIi NOTICE OF
COMMENCEMENT.
1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governtn is
type o work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority violate or c e the
provisions of any other federal,state,or local law regulating construction or the performance of construction.
c
Signature of Owner Signature of Contractor
Print NamePrint Name
' .. `..._ ....._..................................................._..........................
,,.t. �.f...t1+t r+- .......t 51 ....1..'E'... .......................................
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Sworn to and subscribed before mev,
of Scw6 20 �� S orn t nd subscribed before�r me
this Day this a of .20 1 �-
G
1111111„ `,I11 Y p l,
Notary Public ', ;��: u c :z�
= Notary Public•State of Florida , `*° Notary Public•State of Florida
My Comm.Expires Dec 17,2012 .5 �6i' �1�D1r�2®c7,2012
%,' ol��d;•� Commission#DD 846362 °;;;off F� '�� Commission#DD 846362
Doc#20122131-1-03,OR BK 15987 Page 2300,
Number Pages: 1
NOTICE OF COMMENCEMENT Recorded 07;0212012 at 02:11 PM,
JCM FULLER CLERK CIRCUIT COURT DUV'AL
COUNTY
Permit No. RECORDING$10.00
Tax Folio No.
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.
1.Description of property(legal description): �� - ," - C• t '�iG ,
a)Street(job)Address: If Cj_ � e-- r C—
2.General description of improvements:
3.Owner Information -C/ _
�
a)Name and address:
b)Name and address of fee simple title older(if other than owner)
c)Interest in property
4.ContractorInformation --)
a)Name and address: .�►", 4 ' 'r e�r-� '7 ,• .�;
b)Telephone No.: Fax N .(Opt.)
5.Surety Information
a)Name and address: _.
b)Amount of Bond:
c)Telephone No.: Fax No.(Opt.)
6.1-ender
a)Name and address:
Phone No.
7.Identity of person within the State of Florida designated by ow r upon whom notices or other documents may be served:
a)Name and address:
b)Telephone No.: Fax N0.(Opt.)
8.In addition to himself,owner designates the following person receive a copy of the or's Notice as provided in Section
713.13(1)(b),Florida Statutes:
a)Name and address:
b)Telephone No.: Fax No.(Opt.)
9.Expimtion 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 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 FLORIDA
COUNTY OF PINELLAS
Signature of Owner or Owner's Authorized gfficer/Director/Partner/Manager
Print Name
The foregoing instrument was acknowledged before me this ° ", day of s : ;.:i ,20 ±' ,by
as (type of authority,e.g.officer,trustee,
attorney in fact)for (name of party oZbef of whom instru ent was executed).
Personally Known OR Produced Identification/ Notary Signature
Type of Identification Produced Name(print) S o Z 4 nn e
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.
FORMSINOC d2010,.,.,rrr
- - - -..r,
;o`nY A teic SUZANNE LEAVER Signature of Natural Person Signing(in line#10.)Above
E Notary Public-State of Florida
My Comm.Expires Dec 17,2012
Commission#DD 846362
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