863 Ocean Blvd 2012 roof \4r
CIT)' OF ATLANTIC BEACH
800 SEMINOLE ROAD
J ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12- 0001180 Date 9/06/12
Property Address . . . . . . 863 OCEAN BLVD
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
-----Application valuation . . . . 5900
---------------------------- ------------------------------------
Application desc
reroof
--------------------------------------- ------------------------------------
Owner Contractor
------------------------ ------------------------
PRITCHETT MARLIN J D. S . KILLIAN ROOFING &GC (ROOF
863 OCEAN BLVD 3948 3RD ST S BOX 122
ATLANTIC BEACH FL 322335429 JAX BEACH FL 32250
(904) 509-8470
--------------------------------------- ------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 80 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 5900
Expiration Date . . 3/05/13
--------------------------------------- ------------------------------------
Other Fees . . . . . . . . . STA E DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
--------------------------------------- ------------------------------------
Fee summary Charged Paid Credited Due
Permit Fee Total 80 . 00 1-80 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 84 . 00 84 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF LANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
f
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: Permit Number:
Legal Description Parcel#
oor Area o q. t. q. t
Valuation of Work$ ®� Proposed Work heated cooled non-heated/cooled
Class of Work(circle one): New Additi Alteratio Repfir Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial �esidentiaIf an existing structure,is a fire rinhler s to installe ? (Circle ne N/A
Florida Product Approval# Sv?/ �L
For multiple products use product approval form
Describe in detail the type of vo to be performed:
�l� T
o
Proper Owner Information: v
Name: Address:
City Stat G- Zip A-2 55 Phone E - °
E-Mail or Fax# (Optional)
Contractor Information: /
Company Name:�5 i// r!f - f �J= �i Quali yin ge �' s, `C/�e
13t--,
Address: S. City 1�Z . State ,'' Zip o7v23
Office Phone `/ a�Cl<i (mob Job Site/Contact Numb V T JY Fax# V0 7 Y6
State Certification/Registration# 6'CC F:�O
Architect Name& Phone#
Engineer's Name &Phone#
Fee Simple Title Holder Name and Address Ai
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 indicated. 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 las 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 uspended or abandoned fora_period of six 6)months at any time after
work is commenced. I understand that separate permits must be secured for Electri al Work,Plumbing,Signs, Wells, Pools, urnaces,Boilers, Heaters,
Tanks and Air Conditioners,etc.
WARNING TO OWNER: YOUR FAILUE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR P YING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO O TAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
1 hereby certify that 1 have read and examined thislication and know the same to bc true and correct. All provisions of laws and ordinances governing this
0
type o1 work will be complied with whether sped herein or not. The granting o a 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 pertbr Pnance of construction.
Signature of Owner Si nature of Contract
Print Name ���C /F'/rC T" Print Name 1
r, . . ........... ...... .. r.. ........... .. �� ........... . ..........................
Swo t a su scribe re e S ornd subscri be ore e
this ay o 20/2' th s 1 ay of 20-4L
- ----- --- --
lqry P
Nota U �C ` MY COMPv1iSSI0N#DD 957780 lane ra or
EXPIRES:February 14,2014 N`ta C�o.� My Commission DD8 459
Bonded Thr.Notary Public Underviriters 4or A,d" Expires 02/09/2013
v s 1.26.10
�U32 .5-50 4 q53 -�
Doc # 2012191196, OR BK 16058 Page 1003, Number Pages: 1, Recorded
09/05/2012 at 02:41 PM, JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY RECORDING
$10.00
NOTICE OF COINVNIENCEINIENTi
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