Permit REROOF 70 Forrestal Cir 2012 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH FL 32233
INSPECTION PHONE LINE 247-5814
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Application Number . . . . . 12-00001534 Date 10/18/12
Property Address . . . . . . 70 FORRESTAL CIR
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 5200
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Application desc
REROOF
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Owner Contractor
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NOTTMEIER ERIC & TRACY SYNAN D. S . KILLIAN ROOFING &GC (ROOF
1875 BEACH AVE 3948 3RD ST S BOX 122
ATLANTIC BEACH FL 32233 JAX BEACH FL 32250
(904) 509-8470
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Permit ROOF PERMIT
Additional desc . .
Permit Fee . . . . 80 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 5200
Expiration Date . . 4/16/13
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Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 80 . 00 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 ALI, CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: / U Pv� [ Cly. Permit Number:
Legal Description Parcel#
Floor Area of Sq. t. Sq-Ft
Valuation of Work$ Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residential
If an existing structure,is a fire sprinkler system nstalled? (Circle one): e, o N/A
Florida Product Approval# F ,,2 5-35-
For multiple products use product approval form Q
Describe in detail the type of work to be performed: Z,,
Property Owner Information:
Name: e q Address:
e 7
City ? StatqZ Ziphone fJ /3
E-Mail or Fax# (Optional)
Contractor Information:
Company Name: 111W I ZY ��? Qualifyin Agent: />^ZAt 2�
Address: _P4 /2� /a`�- City �x State Zip -3,4-s?3
Office Phone - -766 2 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 indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work wtll be performed to meet the standards of all laws 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 suspended or abandoned for a period of six 6)months at any time after
work is commenced. I understand that separate permits must be secured for is
Work,Plumbing,Signs, Wells,Pools, Furnaces,Boilers,Heaters,
Tanks and Air Conditioners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING 'TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereby certify that I have read and examined thisplication and know the same to be true and correct. All provisions of laws and ordinances governing this
type o work will be complied with whether sr,
ted herein or not. The granting of a permit does not presume to give authority o violate or cancel the
provisions of any other federal,state, or local taw regulating construction or the performance of construction.
Signature of Owner Signature of ContractorDA
Print Name IC.. ............. /...A1C(..t�................................ Print Name ...... //..�...�.) 5............1i.. .. � ..
Swor � and subscribe a rine / Swo and subscri d e ore e
this a f < 20 Z this Da �� 20 2
1�� 01KHAM
a.11
1C * J '�^ OP�1P�11SSI N#DD 957
o E:XPRES:February 14.2014 �, �kPtFIES:Fe rua 14,2 14
.. coded ihru Ncta y°ublic Underwriters "''e�F P ynn��a rhru Notary Public Underom ers evised 01.26.10
..�'.:` —
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No Tax Folio No.
State of ^'- :as County of l
To whom It may concern:
The undersigned hereby informs you that Improvements will tNi made t0 certain real property.and in
accordance with Section 713 of the Florida Statutes,the following information is stated In this NOTICE OF
COMMENCEMENT. .=
Legal description of property
being improved: 7(.> i�Z` '� �� ���� C c ► . .S
Address of property being improved:
General description of improvements:
Owner t C C\ nG1n
1 s (G L h V ( /fit
Address
Owner's.intemst in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
"� •��
Contractor DS Killian Roofin & General Contra tors nc.
' Suite 122 Jacksonville Beach Fl 32250
Address 3948 S. Third st
Phone No.904 246 7663 Fax No904 339 9233
Surety(if any) N/A
Amount of bond S
Address
Phone No Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name N/A
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other
documents may be served:
Name N/A
Address
Phone No.
Fax No.
In addition to himself,owner designates the following person to receive a copy of the Lienor's 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
different date is specified):
jd*Y1ERTHIS SPACE FOR RECORDER'S USE ONLYeslorem, �'; DATE .,n,e
Clr'llof Duval, t°te�v i do.tlas
"r «i by y PLIC
Ih uaelH rueraeM and aftme that aN at soft and deciaraUons d Fbti(�
am um and mate
80.._
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Doc#2012230753,OR BK 16110 page 5277. �"r��.U td A 20I f
Number Pages:1 Notary PubW at Large, Pr C{. Ow"Of r
Recorded 10/18/2012 at CIRCUIT
PM, L4Ycammfcsian
expiras:
JIM FULLER CLERK CIRCUIT COURT DUVAL Personally Known �'1
COUNTY
Produced IdeordRbm �r C
;
RECORDING$10.00