Permit Roof 1964 Brista De Mar 2012 CITY OF ATLANTIC BEACH
r, s) 800 SEMINOLE ROAD
< ATLANTIC BEACH,FL 32233
a°
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00000862 Date 7/10/12
Property Address . . . . . . 1964 BRISTA DE MAR CIR
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 11298
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Application desc
reroof
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Owner Contractor
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NEMECEK FRED C HAGERTY CONSTRUCTION AND
1964 BRISTA DE MAR CIR ROOFING
ATLANTIC BEACH FL 322334524 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 . . . . 11298
Expiration Date . . 1/06/13
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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.
BUILDING PERMIT APPLICA'T'ION
CrrY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845
Job Address: M-4 Q1?,.1S i t4 I Irw(n-l'�s 2 c t,E Permit Number:
Legal Description Wr* 10 1 OPOIT* Z S ELUA Parcel#
Floor Area ot MIT.
Valuation of Work$�L9DU Proposed Work heated/Zoo non-he ated lcooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pooVspa window/door
Use of existing/proposed structures)(circle one): Commercial �iNo, /A)
If an existing structure,is a fire pnnkler system one):. (Circle on
Florida Product Approval it
For multiple products use pr6duct ipprovarform
Describe in detail the type of work to be performed: KIE36l A �T S4.AIL L.Eb 11DOr
Property Owner Information:
Name: `CC �Addre�s : �!
City State
E-Mail
leC"• 2Z
E-Mail or ax it(Optional)
Contractor Information:
Company Name j*'3V a6LT3 R Mi w 00FIN6a,IAL, ?!alifving Agent &21&&
Address: Lu Ci wILIE State Zip Z,2.2
Office Phone Job Site/Contact Number Fax# 1
State Certification/Registration#
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 Thereby 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 o a permit and that all work will be pe ormed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void wo#k is not commenced w#hin six(6f months,or if construction or work is suspended or abandoned for ap¢rind of six6)months at any lime after
work is comm nc¢d !understand that separate permits must be secured for Electrical World P/umbing,Signs, ff'ells,Pools, urnaces, Boilers,Heaters.
Tanks and AI Condtloners,eic
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR UNIPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I here certify that I have read and examined this plication and krraw the same to be true and correct. All provisions of laws and ordinances governing this
type owork will be complied with whether speed herein or not The granting of a permit does not presume to gry ority to violate or cancel the
provrstons of any other federal,state,or local law regulating construction or the performance of construction.
Signatum ofOwne ,�(/t /L�����Ilillliittt,�r Si ature ofContrac
Print Name Ex Plr�o •O� print Name
... ; ...
...�
Sworn to and subscri before me - . N� _ BE X PirP.a
INS
_ Swo o and subscribed be e
this Day of = N m 0 this Day of V _
\J&j Ia.A a M�kx
DDB114°A o P Bbl -
Notary s OF FLOWN O .�` Notary Putl1c �yJ, • BlpQf� .;
/Nllllilll\
NOTICE OF COMNW-NCEMENT
State ofZ tMTax Folio No. _ Q (p " ((,�r(
Countyof DuV&L
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 stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved:
LCA 6 lT i j[I---+ Z 's IL-Wt &j0h 'C
Address of property being improved l q 16A ISE LM6 241F' 04' -A-fu ric IN7 k
General description of improvements:
E�Lu W /
Owner. 't" LO) P35 W(&C`t'( Address: AWA G tt
Owner's interest in site of the improvement: A�ft�T' c
Fee Simple Titleholder(if other than owner):
Name:
Contractor:�A�� (b U SA> LU— J)A.) _OLR1&b1AX -
Address: lt6z Lot Z viout lir, F-L., J Z L
Telephone No.:T6 %1 �Cl�® Fax No: 04 411L
Surety(if any)
Address: Amount of Bond S
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): i,,,.
an y Ga�''%,�
THIS SPACE FOR RECORDER'S USE ONLY OWNER E z p/� O� '%
Signed:
Before W&S day ofQ,DUN&State
Of Florida,has personally appeared = m47/,
Notary Public at Large,State of Florida,County of
My commission expires: '%F
Doc#2012142999,OR BK 15995 Page 1078, Personally Known: ' F (Z � or
Number Pages:I Produced Identificafi r . (.. lrririrltt�
ecorded
l 0,2012 at 10:58
RM FULLrFULLER AK CIRCUITCOURT DUVAL
COUNTY
RECORDING$10.00