1768 Beach Ave Roof 2012 CITY OF ATLANTIC BEACH
CI1�'�
3 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
J.r31.�
Application Number . . . . . 12-( 0001004 Date 8/02/12
Property Address . . . . . . 176 BEACH AVE
Application type description ROO1 PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 6500
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Application desc
reroof
--------------------------------------- I
------------------------------------
Owner Contractor
------------------------ ------------------------
HICKS ANTHONY J A CROWN ROOFING INC
2291 OCEANSIDE CT 2159 ST JOHN' S BLUFF RD S
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32246
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 85 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 6500
Expiration Date . . 1/29/13
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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Fee summary Charged P id Credited Due
Permit Fee Total 85 . 00 85 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 14 . 00 . 00 . 00
Grand Total 89 . 00 89 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF AlLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Doc#2012164011,OR BK 16021 Page 1438,
NOTICE OF COMMENCEMENT
Number Pages 1
Recorded 08/02;2012 at 02:47 PM,
JIM FULLER CLERK CIRCUIT COURT DUVAL
Permit No. COUNTY
Tax Folio No. RECORDING$10.00
TIS UNDERSIGNED hereby gives notice that improvements will be *to certain realrope
rty,and in accorda
713.13 of the Florida Statutes,the following information is provided int is NOTICE OF COMMENCEMENT. nce with Section
1.Descri tion of property(legal deser' tion .
a)Street(job)Address: 4 4AC In { ^ ELa
2.General description of improvements: - r
3.Owner Information &simple
a)Name and address:b)Name and address tit eholder(if other than own
c)Interest in property
4.Contractor Information
a)Name and address: /► C
b)Telephone No.: L, l �
8 Fax No. (Opt.) L
5.Surety Information
a)Name and address: '
b)Amount of Bond:
6.Lender c)Telephone No.: Fax No. (Opt.)
a)Name and address:
Phone No.
7.Identity of person within the State of Florida des/ ted y owner upon whom notices or other documents may be served:
a)Name and address: ')Z41AI. ,
b)Telephone No.: Fax No. (Opt.)
addition to himself,owner designates the following person to receive copy of the Lienor's Notice as provided in Section
713.13(1)(b),Florida Statutes:
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 SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSt IT YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF CO ENCEMENT.
STATE OF FLORIDA
COUNTY OF PINELLAS
x;`.10.
Signatureof er or' er's Authorized Officer/Director/Partner/Manager
Print Name
The foregoing instrument was acknowledged, efore me this day of fs z- 20/ by
as (type of authority,e.g.officer,trustee,
attorney in fact)for (name i f party on behalf of whom instrument was executed).
Personally Knowny`�
OR Produced Identification Notary Sig ature .-
'
Type of Identification Produced Name ri y r v
OR ,.
Verification pursuant to Section 92.525,Florida Statutes.Under penalties of p u cl a Ift at I Ha a oing and that
the facts stated in it are true to the best of my knowledge and belief. lotary Public State of Florida
William Ro Jr
My ass" EE 183470
FORMS/NOC,rvsd2010 � r`�
Signature of latural Person lg i
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantis Beach, FL 32233
Office (904)247-5826 F aix(904) 247-5845
Job Address• nuq nU Permit Number:
Legal Description U- O 0,9- Jr-2 +,//S"
Parcel#
� OPoor ea oI"�q�'t, it
Valuation of Work$
Proposed Work heated�cooled �� non-heated/cooled
Class of Work(circle one): New Addition Alteration Rep"'r Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial I'
If an existing structure,is a ire s ri kler syste �* taIIW9 (Circlene): �YesoN/A
Florida Product Approval#
For multiple products use pro uct approva
Describe in detail the type of work to be performed:
Property Owner Information•
Name: Address:_ ��•�s�� C/-
City Stat _Zip Zz33 Phone j 5;� - 76.i P
E-Mail or Fax#(Optional)
Contractor Information:
Company
om an e:B ILT116 1 rl�' f�
P y Quali ng Agent: ��
Address R City I l State �'(, Zip
Office Phone v Job Site/Contact Number Fax# /
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 hereby made to obtain a permit to do the work and installations as Indic ed. 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 law 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 s ended or abandoned for a-period of six(6)months at any time a�ter
work is commenced. I understand that separate permits must be secured for Electric Work,Plumbing, Signs, Wells,Pools, Furnaces,Boilers,HeaCen,
Tanks undAir Conditioners,etG
WARNING TO OWNER: YOUR FAILUR TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PA ING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OB AIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFO RECORDING YOUR NOTICE OF
COMMENCE NT.
I hereb certify that I have read and examined this a plication and know the same to be e and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether speci ied herein or not. The granting of 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 perform nce of construction.
KSignature of Owner `
Sigi ature of Contractor
Print Name-
.T''..... .3....._....._... . ../..................................................... PrmName ' . , ,,,�... -... ...:�� ....
Sworn to and subsc ' ed before me ...................
Sw to and, s before e
this Day of this.44_ y 20
211. Notary Public state of Florida
Notary Public nn
yCommission EE 193470 of
or R Expires 04/26/2016 MY COMMISSION EE123334
4 ' E-N >xES:
' *ARY Fl.N%,,, '2 sed 01.26.10