1270 Hibiscus St roof 2012 jfa
~' CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12- 0001061 Date 8/15/12
Property Address . . . . . . 127C HIBISCUS ST
Application type description ROO1 PERMIT
Property Zoning . . . . . . . TO EE UPDATED
Application valuation . . . . 4968
--------------------------------------- ------------------------------------
Application desc
reroof
--------------------------------------- ------------------------------------
Owner Contractor
------------------------ ------------------------
MILLNER WALTER AMELIA ROOFING INC
1270 HIBISCUS ST 5756 HECKSCHER DR
ATLANTIC BEACH FL 322332664 JACKSONVILLE FL 32226
(904) 333-6496
--------------------------------------- ------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 75 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 4968
Expiration Date . . 2/11/13
--------------------------------------- ------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
--------------------------------------- ------------------------------------
Fee summary Charged faid Credited Due
----------------- ---------- --- ------ ---------- ----------
Permit Fee Total 75 . 00 75 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 79 . 00 79 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF VILANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT PLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax(904)247-5845
Job Address: Z Permit Number:
Legal Description 146-- arcel#
oor Area o q. t. Sq.Ft
Valuation of Work S Proposed Work beate /cooled non-heated/cooled
Class of Work(circle one): New Addition Alteratio Re air olition pool/spa window/door
Use of existing/proposed structure(s)(circle one):. Commercial Residenti
If an existing structure,is a fire sprinkler system installed?(Circl one . � o N/A
Florida Product Approval# q - /2
For multiple products use product-approval
Describe in detail the type of work to be performed:
Property Owner Information:
Name: . Address: l
StateZip ;�City a _Phon
E-Mail Optional)
Contractor Information:
Company Name: K-A. 6C,4y4 �_ _,cd F. Qua ifying Agent: C��
Address: City State 4�Ez Zip
Office Phone Job Site/Contact Number 3 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 ind Gated 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 a111 ws regulating construction in thisjurisdiction. This permit becomes mill
and void if work is not commenced within six(6)months, or if construction or work i suspended or abandoned for apertod of six(6J months at any time after
work is commenced. 1 understand that separate permits must be secured for Electr ca! Work,Plumbing,Signs, Wells, Pools, Furnaces, Boilers, Heaters.
Tanks and Air Conditioners,etc
WARNING TO OWNER: YOUR FAILTO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR P YING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTENT) TO TAIN FINANCING, CONSULT WITH
YOUR TENDER OR AN ATTORNEY BEFO RECORDING YOUR NOTICE OF
COMMENCE ENT.
1 hereby certify that I have read and examined thisapplication and know the same to true and correct. All provisions of laws and ordinances governing this
type o work will be complied with whether speci ted herein or not. The granting a permit does not presume to give authority to violate or cancel the
7anne
other federal,state, or�l law regulating construction or the perfo mance ofconstruction.
Sigwner ' S gnature of Contrac0>. .. 4C z`�,��'...G��. 1. 1PriPint Name
Sworn tt
re me S orn scribe ore me
thi Day 20 Zth s -'" ay o 20
pl r SHIRLEY L.G
No—taTMW . iSSION k
CCry
EXPIRES:February 1 �^ .�. EXvIruary 14,23 Bonded thio Notary Public Ui emir ters a onded Public l@ryini 01.26.1 0
AUG-15-2012 09:08 FROM:CLERK OF COURTS 904 270 1512 TO:92475845 P:1/1
NOTICE OF COMMENCEMENT
(PREPARE IN SUP CATE)
Permit No JA^6666- e-0_ Tax Folic No.
State of 1 1 �"�, County a 1_ 2;t-A I
To whom It may concern:
The undersigned hereby Informs you that improvement will be made to certain real property, and in
accordance with Section 713 of the Florida Statutes,the fol owing Information is stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: </
APR-2-3 S
Address of property being improved: 3
General description of improvements:
Owner
Address � � �
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor "
Address �.
Phone No. ' �',�
Surety(if any)
Address Amount of bond $
Phonp..No_ Fax NO,
Name and address of any person making a loan for the constrL ction of the improvements.
Name
Address
Phone No. _Fax No.
Name of person within the State of Florida,other than himself, Jesignated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself, owner designates the following person tc receive a copy of the Lienors.Notice as provided in
Section 713.06(2)(b), Florida Statutes. (Fill in at Owner's option).
Name
Address
Phone No. Fax No
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a
dlffemnt We is spedf;ed):
THIS SPACE FOR RECORDER'S USE ONLY = WNERi
Doc#7.012173602,OR EK 16034 Page 11496, DATE
Before mg(iii .- day Of In the
Numt)er Paces: 1 County of Duv 1,State of Fl a,has pert pally appeared
pr�:orded 0$115/2.012 at 09:32 AM, Brain by
11M FULLER CLERK CIRCUIT COURT DUVAL himaelU ncrae aha arrrms that au statements and aeclaratlQns herein
COUNTY are true and a curate
P.ECARDING$10.00
Notary Public it Large,State ofCounty Of
N -w-
My"'
y cvmmissl a iras:
H19LV L.GRA4AM Person n wn
1svGOW8810N4DD957760 Pr ed de ificat'
r•,XPIREB:Feb=ry 14,2014
eorded Thri WtM PdW unlmwhen