103 Saratoga Cir (vault) asA.3e.: CITY OF' 520
dJ Otlice of ulltliny 011iclal
REQUEST FOR INSPECTION
Dale All No,
PERMIT Time ^.M. Nil No.
„p.oit
14.lmher Hacelwa��;----T—P.M.
Jo Urea } IaaleY .___-
'pnetr . Type Hama° catramor�l��`^ SL'�PI//Lr
P OpOSed Use BUILDING CONCRETE LE TRI AL PLUMBING MECHANICAL
,.W hip 8: r- Air.Cord.B ❑
g Framing ❑ Foo '� em Pole np C TOD OW ❑ He llnp
'd9 imated Val' Pogxlinp O $lao Flre Plain ❑
Imprev . CO. llnlel ❑ A//ll We Fee
T y t Ele. READY F IR INSPECTION A.M.
Mon. FE wed/r�. _ Than. Fril P.M.
I7 AM.
) i -a. ImpWllan Made ( P.M.
q 1 Flaw In°psllon❑
- k walor me _. ...
cenniraeot aruPaoar
OWI Coat•
yMET
5 -3 WATER METER SO -^^
RADON GAS-H.R.S. SO ^'
nNTRACT T, TNF- 11;,rf N _ .. _ .. - .. EADON . GAS - 5 _ $0_0^
F:. SE..i . _;: . I WATER TAP`. S0 .
. . FEL: I SEWER TAP. . $^-
1,71 NV HYDRAULICC SHARE I
-, qui:;; RE-INSPECT FEE SO . OD
-:li?C-#}-iiil'irc"P-PEE z•..:x�4aa$0 �8�`
nTHF.F:
NOTES:
NOTICE—ALL CONCRETE FORMS AND FOOTINGS M ST BE INSPECTED BEFORE POURING
PERMIT VOID SIX MONTHS AF1 ER DATE OF ISSUE
BUILDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK NO UST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE
CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR 0 NNER
"FAILURE TO COMPLY WITH THE MECH NICS' LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS."
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART F THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
ATLANTIC BEACH BUILDING DEPARTMENT
j
BY:
CITY OF ATLANTIC BRACH, FLORIDA
APP. ev APPLICATION FOR ELECTRICAL PERMIT
TO THE CHIEF ELECTRICAL INSPECTOR: DATE:-
IMPORTANT
ATE:IMPORTANT NOTICE:
IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE WORK AS DESCRIBED IN THE FOLLOWING, WE
HEREBY AGREE TO PERFORM SAID WORK IN ACCORDANCE WITH THE ATTACHED PLANS AND SPECIFICATIONS.
WHICH ARE A PART HEREOF, AND IN ACCORDANCE WITH TH ELECTRICAL REGULATIONS, CODES AND CITY OF
ATLANTIC BEACH ORDINANCES.
irk UJ CC cl9i 7-4t6 ?, „4: j
ELECTRICAL FIRM: MASTER R ELECTRICIAN SI NA ORE JOURNEYMAN
NAME.
IAbDRESS:_ /G . , - � RFD_BOX_
_ ----v
BLDG.SIZE BETWEEN: >Ik/
RES.1 l/ APT.1 1 COMM.( 1 PUBLIC( I INOL S.( ) NEW( 1 OLD(,'1— REW.( 1
ADDITION ( 1 TRAILER ( 1 TEMP.1 1 SIGNS 1 ) SD. FT.
SERVICE: NEW( 1 INCREASE IN - REPAI ( ) FEE
CONDUCTOR SIZE d AMPS /I (l PER ALUM.
SWITCH OR BREAKER � ) �� AMPS / PH W u MOLT -ef RACEWAY
EXIST.SERV.SIZE SOU AMPS PH W Z VOLT RACEWAY
FEEDERS NO. SIZE NO. SIZE NO. SIZE
LIGHTING OUTLETS CONCEALED OPEN TOTAL
RECEPTACLES CONCEALED OPEN TOTAL
0.30 AMPS. 51.100 AMPS.
SWITCHES
INCANDESCENT
FLUORESCENT IL M.V.
FIXED 0100 AMP.. OVEfl
APPLIANCES BELL TRANSF.
AIR H.P.RATING H.P.RATING
CONDITIONING COMP.MOTOR OTHER MOTORS kMPS CEILHEAT: KW-HEAT
0-1 OVER
MOTORS H.P. VOLTAGE PHS NO. 1 H.P. VOLTAGE PHS
MISCELLANEOUS
5733
DEPARTMENT OFBUILDING
CITY OF ATLANTIC E EACH
-- PERMIT INFORMATION ----- LOCATION INFORMATION — -
Pe mit Humbert 5733 Address: 103 SARATOGA CIRCLE
Permit Type: MECHANICAL ATLANTIC BEACH, FLORIDA 32233
Cites of Work : NEW -- -- ------ LEGAL DESCRIPTION ------- -- -
C nstr. Type: WOOD FRAME Lot: Block: Section:
P oposed Use: SINGLE FAMILY Township: RNG: 0
Dwellings: 1 Code: O :ub ivision : ROYAL PALMS
Estimated Value: 90. 00
Improv. Cost : 90. 00
Total Fees : 547. 00
Amount Paid : i 947. 00
Date Paid: 7/30/92
Wo k UaeL INSTALL CENTRAL HEAT AND Aln
--- - - OWNER INFORMATION ---- - APPLICATION FEES -----
Name: LAMONDOLA PERMIT 947. 00
Ad res, : 103 SARATJGA CIRCLE WATER IMPACT FEE $0. 00
ATLANTIC BEACH, FLORID,! '. SEWER IMPACT FEE 90. 00
F!,au - (904 )725-4402 WATER METER SO• 00
RADON GAS-H. H. S. 50. 00
- - CONTRACTORINFORMATION - RADON GAS - 57. $0. 00
Name : ARLA NGTUN AIR CONDITIONINL WATER TAP 90. 00
Address: 1930 UNIVERSITY BOULEVARD SEWER TAP 90. 00
JACKSONVILLE, FL 32211 HYDRAULIC SHARE 90. 00
n..•n Kr RM0015G99 Type. 0 REINSPECT FEE 90. 00
SEC. H IMPACT FEE 90. 00
OTHER $0. 00
NOTES'.
NOTICE —ALL CONCRETE FORMS AND FOOTINGS M ST BE INSPECTED BEFORE POURING
PERMIT VOID SIX MONTHS AF1 ER DATE OF ISSUE
BUILDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK M UST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE
CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR O NNER
"FAILURE TO COMPLY WITH THE MECH NICS' LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS."
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW. -
ATLANTIC BEACH BUILDING DEPARTMENT
BY
BUILDING AND ZONING INSPECTION DIVISION
CITY OF ATLANTI BEACH
ATLANTIC FLORIDA 32233
APPLICATION FOR MECHANICAL- PERMITMp
IMPORTANT — Applicant to complete II items in sections I, II, III, and IV.
1.
LOCATION trr..r Add....: _ ✓—
,
OF lOwndina sheNn Eel.... A 47 Ane
11UILDIN6
S.bdbbisn _ _
11. IDENTIFICATION — To be completed by all applicants
M <emld.nYen f grmil q;... for dine lh.,n .< dn<rib.d in III. .b .. .r.q.e.nr .. har.bv .e,.. rex .,f, .;d +o •
M. .11.,W v1..n .•d rgdli<.r:em .hl<h .r. . p.n br.el ..d in e¢erd.nw +nn 1%. Cary el Jukl. LTe erd,gr It,
d geed q.<!<. .,A rh. l..
Ms. N M"h..kN A
CWYWNr Ihintl yy�/Y nn C /2l, .hr
N..wN
tip.w. N
ASA.
.r A
AaNWiud
AS.., A bifid er Enyinur r
111. GBiRALINFORMATION
A T IE OTHER CONETOUCTION aCINO DONE ON
THIS NILOINO 011 SITE?_ /�7j,
O G.•—O V O N.Nni O CentW WEST
IF TES• GIVE NINAaEII OF CONSTRUCTION
O Oi PERMIT
Q OIL.r — SPMNy
IV. AIECKAN" SOUWkW T TO N INSIA1/JO NI-A1TURjOP WORK
�1 aryMe Ert N wywnb ell Md of thk t�rw� y Reel".11al 0r I1 Commercial 7,�)
p 1Met Q fpu Q it"NMa d Cf C .het O Nw ❑ Now Building
�rf'r IIIEI 0 Msw✓�P T r 1. 1� gL ExWnq Suneing
On( Sy.Nnr ❑l Racplacamant o1 existing system
ala.4w. "PMN, I ;;! �� p—TGRF ImWMlbn(N0 eplam W"10u91y lnablladl
O M'Irisuelian ❑ En1015100,or add on to existing system
O Case" M. - - C.PeNry SM ❑ Other — Specify_
❑ R. wnwll.r.: N.mbr of
O I4.eMr O M.Aft Q f.ral..•� IaaNbW) TNN >•AI OF PYN ONLY
O G.raEr psP (aambet) (OR OFdi
O T-AG I..bW) tMaMl,
O IPG ._. laawbWl
O U.Rrad PreNwa.aNr
O MEWS IMR4 Apesswed by O.,.
O 00P— EPeaii, I N FOI
LJSP ALL HQUIPMEWr t
AM COMXIIOMNO AND REFRIGERATION F.QUVNENi
ITemMTDen. DuCHPUM Masai NOSS" Nanutact T Cf=
ty A4Eo� 17 ` •J
i
HEATING < FURNAML ROILPR._ PIRISK II s.
580U
DEPARTMENT OFBill LDING
CITY OF ATLANTIC I EACH
----- PERMIT INFORMATION -- --- - - - - — - LOCATION INFORMATION - --
Permit
—Pelrmit Number: 5808 Add eas: 103 SARATOGA CIRCLE SOUTH
Permit Type: RE-ROOF ATLANTIC BEACH, FLORIDA 32233
Claes of Work: NEW --- ------ LEGAL DESCRIPTION ----------
Constr. Type: WOOD FRAME Lot Block : Section:
Proposed Use: SINGLE FAMILY Township: RNG: 0
Dwlellings; 1 Code: 0 Sub ivision: ROYAL PALMS
Estimated Value: $0. 00
Improv. Cost : $0. 00
Total Fees: $22. 50
Amount Paid: $22. 50
Date Paid: 6: 19/92
work Derr_. : REPLACE OLD ROOF WITH 45 SOUA E SHINGLES AND FELT
-- - - - - - OWNER INFORMATION -------- - ---- APPLICATION FEES -----
Name: CARMELO LOMENDOLA PERMIT 922. 50
Addrese: 103 SARATOGA CIRCLE SOUTH WATER IMPACT FEE $0. 00
ATLANTIC BEACH, FLORIDA 322-3 SEWER IMPACT FEE $0. 00
Phone-: (904)246-7905 WATER METER 00. 00
RADON GAS-H. R. S. 50. 00
- --- --- CONTRACTOR INFORMATION -- -- - - RADON GAS - b% SO. 00
Name: DBA ISENHOWER ROOFING WATER TAP $0. 00
Address: 212b BELINDA CIRCLE SEWER TAP $0. 00
JACKSONVILLE, FLORIDA 32216 HYDRAULIC SHARE $0. 00
License: RC0026590 Type: 7 RE-INSPECT FEE $0. 00
SEC. H IMPACT FEE $0. 00
OTHER 40. 00
NOTES:
NOTICE—ALL CONCRETE FORMS AND FOOTINGS MU T BE INSPECTED BEFORE POURING
PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE
BUILDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK M ST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE
CLEARED UP AND HAULED AWAY By EITHER CONTRACTOR OR OV NER
"FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS."
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
ATLANTIC BEACH BUILDING DEPARTMENT
By:
CITY OF ATL NTIC BEACH
PERMIT APPLICATION ROOFING
Owner(s): 2 �C
Address:
5 Phone: 2C//,
Lot # Block or Unit #
Subdivision
Contractor; --S
Address:-2
Phone:
State License No. 0
S
Describe work to be done: SF (D l
L _ tiD Q L ;
Materials to be used: k,
Signature OWNER: '
Date:
Signature CONTRACTOR:
DEPARTMENT OF BUILDING FOR OFFICE USE ONLY
CITY OF ATLANTIC BEACH, FLORIDA Date,3-,�__ig ]y
----- ------ Permit # Fee yn
Application for Permit Valuation $
f r Miec. Alterations House #�Q �.eZ6¢a &,t.6-
nd Aepairs L
DESCRIBE:
(state if to repair, alter, add to or move building, erect awnings
or signs . etc. )
Building on: Lot No. Blk No. j Sub Div
Address / aluation $
Owner's Name
BUILDINGS & DCCUPANCY �l
Building Use - Residential or Businesspp��iniyc�
What Plumbing work to be done
Size of Present Bldg. Size f Extension
Lot size Material f Rooms
No. of stories now after altered
Material of Present Building Material of Extension
PLANS MUST BE SUBMI TED HEREWITH
SIGNS
Size Classification _
(state whether gr end, roof, wall, projecting
banner)
Material of Construction
Illuminated) Type of illumination _
(Stat . whether lamps or neon)
Will sign be over public property
SUBMIT DRAWING SHOWING CONSTRUCTION 01 SIGN AND METHOD OF HANGING
WRITE ADDITIONAL INFO TION BELOW
(For canvas awnings provide dimensioned drawing on reserve side)
IMPORTANT NOTICE:
In consideration of permit given foi doing the work as described
in the above statement, we hereby agree In perform said work in
accordance with the attached plans and s ecifications, which are a
. part hereof, and in accordance with the luilding regulations of the
City of Atlantic Beach. 6outhern Stands d Building Code)
Signature o ui er or ner
Address O Phone
DEPARTMENT OF BUILDING FOR OFFICE U ONI'
CITY OF ATLANTIC BEACH, FLORIDA Date � 1'
----------- Permit #_ a $�
Application for Permit Valuation $ n
tur niec. A], Rts�a� nm§A #
and Repairs
DESCRIBE:
(state if to repair, alter, add to or rove building, erect awnings
or signs, etc. )
Building one Lot No. X— Blk No. Sub.Div. ZZ? %�
OwnerAddre's Name V luation $ .C.J
BUILDINGS & O CUPANCy
Building Use - Residential or Business
What Plumbing work to be done?
Size of Present Bldg. Size o Extension
Lot size Material of Roof
No. of stories now after altered
Material of Present Buildingterial of Extension
PLANS MUST BE SUBMITTED HEREWITH
SIGNS
Size Classification
(state whether ground,er)roof, wall, projecting
Material of Construction b nn
Illuminated? Type of illumination
Will sign be over public property? (State whether lamps or neon)
SUBMIT DRAWING SHOWING CONSTRUCTION OF EIGN AND METHOD OF HANGING
WRITE ADDITIONAL INFORMATION BELOW
(For canvas awnings provide dimensioned drawing on reserve side)
IMPORTANT NOTICE:
In consideration of permit given ford ing the work as described
in the above statement, we hereby agree to erform said work in
accordance with the attached plans and spec fications, which are a
part hereof, and in accordance with the bui ding regulations of the
City Atlantic Beach, gouth t dard` uilding Code)
Signature of Builder or Owner �,�
Address
Phone
/03 cr.8ad7e .e ei2 .
S�pQ 4
7//9/73
n
OWFL LB✓/Frt � � � �� ,
rj[fSS f!id'i� AOR.
/Q J c�'iB/1�dT0 '.B Lei/2
L' .i S CoNSTa�e�io ✓ C. aopesr� To Z?/.CAC
Coorrso-� Jli9N a�;r.,, Px8xr6 Cl�r:✓r .QlaeK o?X/OPI.rrF o.✓ ,dE� �
CoaNrn. loesr �.-,rrr �x y .✓
�/✓/TN �l/a�,ar..v .j'CRE'E� C t ,op t�a, Y" To .OF o'1 X o.✓ o?S/ '�
Ce"i✓Tt7s STIe �r rN /X F/ yifrF /'ei F T 9E of R,aro V y /S/ lir✓wi
SNre-ri,.p .9211 /Ivww• is 'ex 7'0 dE' R eexr ,zr- TaraTrn , "Ir -;w,[e .(!E /I
VSWIuE %3oe. o
4
000293
DEPARTMENT OF BU LDING
CITY OF ATLANTIC BEACH
PERMIT INFORMATION _ LOCATION INFORMATION - - -
- Add+ ss+ 103 SARATOGA CIRCLE SOUTH
r411t Numbers 293
Type: FENCE ATLANTIC BEACH, FLORIDA 32Z+
P#rmit T➢p LEGAL DESCRIPTION
-.qa of Works NEW Lot : Block: Section:
,.rpatr. Type: WOOD Plat Books Pages O
r r Oposed Use: SINGLE FAMILY 5ubd vision:
.ePuingse O Code: O OWNER INFORMATION
:.:Llmated Value: 40. 00
9314. 57 N mex CA 103 S RATOGA CA
Improv. Cost . $0. 00 Addr .ae: 103 SCR BEACH CIRCLE SOUGH
Total Faess ATLANTIC BEACH, FLORIDA 32233
Am,m,,L Paid: 60. 00
Ph nes (904)296-7905
Paid :
,. „ I I .. . : INFTALL Al ION OF FENCE: NOT 'i'0 EXCEED 6 FEET IN HEIGHT REAR YAW'
r'ONTItACTORI:� - " ' ' " - APPLICATION FEES --- - -
$0. 00
IMPACT FEE 30. 00
IMPACT FEE 50:00
M6'TER 40.00
GA:.-N. R. S. $0. 00
GAS - �'I $0. 00
TAP 90. 00
TAF 90. 00
JLIC SHARE 90. 00
_.PECT FEE 90. 00
$0. 00
y{l. Ot)
NOTES:
NOTICE—:ALLCONCRETE FORMS AND FOOTINGS M ST BE INSPECTED BEFORE POURING
PERMIT VOID SIX MONTHS AF ER DATE OF ISSUE
BUILDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK h UST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE
CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR C WNER.
"FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYING TWICE OR BUILDING IMPROVEMENTS.”
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART F THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW,
ATLANTIC 7BEACH BUILDING DEPARTMENT
I"1!:1:arr DECCRlI•TIOU CITY U1=
t.*
Lotp,--------Ulocl: F11GUCEN1IR)ULEVARD
---------erection 9
R U.IIVI Oil
AI'LAltlIr'ILEA/'11,I
'1TA.1:1'11011E I W dl;:1!r'in.5
:rt Ilmnc �J
Add x_ ----3 //`ma�yy LL��11�� / /A - DESCRIPiIOR OF WORI:
11 in o FI(OUO-IIAZARD
flno.l Znnp: com VV
I>aga 3.
Duncrip Alun xrc-�
I2Aase a1 We'll:
INew/Remodel/Addition x_ --
:.01 i.IIG IIIFUIi IIA'1'I UH
�e o1
Cones truction: ��mm
[md.r'9 I'rr.yurad
Din Grictx U., a�
--------- ----------------- L�_.timatsd Values /
�1� s
F.>:ceptionn or
VurAuneeu Oronlnd: (Jfmtnrl.".tux
Solid or
___ _______________________________________ Filled '
Uround:-------------itoo£:
UWIIEII IiiFUF.II A"1'II111 ----------- -
Oethod o1 Heating:_________
Property
It"S 11ng --� ______ Phonex '7`(Q
Atldrevv ib3
,_a
-- -- - -- ---------------
CUgrRACI'Uh IRFUIIIIA'IIO11
Centroo Lor:_ I
Iloqilin ------------------ Phonex
Atldreca•
_________________________________
Llecn.^.e Iixnnber; Data:.tion
L> connlderation of permit Divan for doing Use xul )c ao devcribed
the "bove vtatement, we hereby agree to rfonn vaid xorl:
'J!i��'-;:" accordance vith the "'tach d lana and a e.ificnti.n. xh£cGale
In
+� �'•• � :> park Imreof, and in ace rdance with
all rulev
of tand regulatlonv
he City o£ Atlantic ge ch.
1 I A
/ F,( /! Uxuc•r SignatureF_E
_....__.._ .._.._ - 6YlL�-Lt�----`Dote
Contractor Signature Date
FLOODPLAIN DCVLLO MENT INFORMATION
Type of Development:- New Building
Alterations to Existing Building
Floud %uuc
Required Floor Elevation
Actual (as built)Lowest Floor Elevation
If located within a flood hazard zone ..(zone A) a survey must be
made after the slab lies been poured� certifying that the "Lowest
floor elevae_o_n fs equa to o or a ove the base 'flood elevat�- o�u
esta6l-isieoi that zone. ,
No Final Inspection will be made and o Certificate of occupancy
will be issued until the survey is on file with the Building Department.
COI-MENTS
Applicant acknowledgement : I underst nd that the issuance of this
permit is contingent upon the 'above 'i formation being correct: :in,]
that the plans and supporting data haie been or shall be provided
as required. I agree to comply with tII applicable, provisions of
Ordinance No. 25-7-11 and all other 1 ws or ordinances effecting
the proposed developemnt.
Date Applicantis S gnature
Department Use
Survey filed with the Building Departient on
Certified Lowest Floor Elevation
Required Lowest Floor Elevation '
Building Department Representative _
t
65?0
PSR-3844
DEPARTMENT OF BL ILDING
CITY OF ATLANTIC E EACH
fl,
Township : RNG :
�,y ---- LOCATION INFORMATION -----—-
_.. ' 103 SARATOGA CIRCLE SOUTH
ATLANTIC BEACH , FLORIDA 3..3?
------ LEGAL DESCRIPTION ---
Block : Se-tion
T '. vision: ROYAL PALMS
r11 ---- APPLICATIONJJA FEF
PER
SE FF'
WATER METER
RADON GAS-H . R. e
- tADON GAS - 59
WATER TAP ..
SEWER TAP
HYDRAULIC SHARE.
RE-INSPECT FEE
i�F.C:-H--IMf#1 'R
NOTES:
NOTICE —ALL CONCRETE FORMS AND FOOTINGS N UST BE INSPECTED BEFORE POURING
PERMIT VOID SIX MONTHS Af TER DATE OF ISSUE
BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK IAUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE
CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER
"FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS."
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
ATLANTIC BEACH BUILDING DEPARTMENT
BY:
CITY OF ATLANTIC BEACH
PERMIT APPLICATIO ROOFING
S � --- ---
Address: Phone:
Lot # Block or unit # Subdivision
Contractor: !�/J/e
2� 7/ n
Address:-.
� = g ,Phone:
State License No. x, B I
Describe work to be done: 08 r
a
Materials to be used: �/ �•�
Signature OWNER: Date-
Signature CONTRACTOR: __