358 4th St roof 2012 ?S IJ.
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Jai
Application Number 12- 0001008 Date 8/03/12
Property Address 358 4TH ST
Application type description ROO PERMIT
Property Zoning . . . . . TO E UPDATED
Application valuation . . . . 8690
--------------------------------------- ____________________________
Application desc
REROOF
Owner Contractor
________________________ ___
FULFORD JUNE ET AL SHORE ROOFING COMPANY
358 4TH ST 914 7TH AVENUE SOUTH
HASON BRITTANY J R/SJAX BEACH FL 32250
ATLANTIC BEACH FL 32233 (904) 241-8842
_____ ________________________________
Permit . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 95 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 8690
Expiration Date . . 1/30/13
_______________________ _____ ______ ___ _ _
Other Fees . . . . . . . STATE DCA SURCHARGE 2 .00
STATE DBPR SURCHARGE 2 . 00
________________________ ___ ------------------------------------
Fee
_______ __Fee summary Charged laid Credited Due
----------------- - --- ------ ---------- ----------
Permit
--------
Permit Fee Total 95 . 00 95 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 99 . 00 99 . 00 . 00 . 00
PERMIT IS APPRONED ONLIIN ACCORDANCE NIIH ALL C'.ITI' OF TLANH( BEACH ORDINANCES AND 'C HE R.ORDIA
HE ILDIFG CODES.
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Dec#2012164640.OR BK 16022 Page 903
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RM FULLER
CLERK ai CIRCUIT
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LRY OF ATLANi1C Bc`'j�`CH
ROOFING PERMR APPLICATION
Job Add. -3
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Address: 3.,54E 17 tr Tebv rm: 21yG -cxiG sl
Roof Contractor: StiJ/l. � brut � ;, Rate Licen Number.
coabarmrs Add.
Tawm, �'11 -� H2r <a>E 41 -�sSY3
$cope ofWak Rr g„� FAetaWl S I
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,WARNING TO OWNER.- YOUR FAILURE TD RECOW NOTICE OF CO WMERCEIWENT MAY RESULT M YOUR PAYING
TWICE FOR IMPROV9NENT.S TO YOUR PROPEIFFY.A MUM OF CM MUST BE RECORDED AND POSTED
ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU MMD To OBTAIN MNANON% CONSULT WITH YOUR
LENDER OR ANATTORNEYBEFORERECORDING YOURNODCEOF MEMCOl1ElYP
SIGNATUREOFOIN h"/ Dat.
AS TOOWNER�medds day
�1Mv 20
OTPBi1YofWval
– ESTATE OF FLORIDA NOUrTrs SlDla4ae:
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_--SIGNATURE-OFCONTRAMR:_ /
AS TO CONTRACTOR:
Swum bo and mbsaibd before medOsdaY of 20–a.
Sete of FlmW CmsitT'of Duval1.p_
Notary'sAgnetur>r �,.
o ljie: era:�oPoe�_<J(rM.5x4RRuP
Type of klentifk ation Pfd
Sn HOTO,RY PUBLIC
ILI �I A TE OF FLORIDA 800 SeNeaM Road AtlarNceeadr. 3II338M8
' +COmrn#DD0933778 Tekpbare: I9at1 JA7-5YW'Fax ex 4)W-S 5 7
^':vice 1 Ta Expires 10130/2013 JAS