355 Sailfish Dr roof 2012 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
j ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00001549 Date 10/22/12
Property Address . . . . . . 355 SAILFISH DR
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 4800
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Application desc
reroof
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Owner Contractor
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KODADA, STAN H ATLANTIC TOTAL SOLUTIONS
355 SAILFISH DR 15153 N MAIN STREET
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32218
(904) 757-9641
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 75 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 4800
Expiration Date . . 4/20/13
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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 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 ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
L (Office(904)247-5826 Fax(904)247-5845
Job Address: 5 S 6u l f r S h b✓,• pIht UP! Parcel Permit Number:
Legal Description S_ C 8
I #
r rea o 9 t 0 non heated/cooled
rt
Valuation of Work$ 7l � • � Pr000posed Work heated/cooled /(.e/
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial esidential
If an existing structure,is a fire sprinklers stem installed?(Circle one): es o N/A
Florida Product Approval# L '
For multiple products use product approval form
Describe in detail the type of work to be performed: ZZ-1-oUT
Property Owner Information: cc /
-�{� GLC- Address:
Name:
City - State Zip_32 aontPhone -
E-Mail or Fax#( ptional)
Contractor Information:
Company Name: r �t I SIyU/�?yn5_._Qualifym' gent: / State /- Zip
Address:LV J l n S�- City y
Office Phone 7 rlG�/� Job Site/Contact Number �7'
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 will be performed to meet the standactionrds of all laws regulating construction in this jurisdiction. This permit becomes null
and work void
o commenced. I understand that sepacommenced within six rate permits muor st be sconstecured for Electrical Work,Plumbing,Sagor work is suspended or es aWer
ells Piod o ls, u)rnaces,sBoileys t 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 ATTORNEYBE OR ENTE RECORDING YOUR NOTICE OF
COMMENl hereb cert that l have read and examined this a plication and know the same to be true and correct All provisions of laws and ordinances governing this
type of work will be complied with whether sppeci ted herein r not. The granting oja permit does not presume to give authority to violate or cancel the
provisions of any other federal,stat or loco!env regulatin n ion ort performance of construction. n
Signature of Own ,/ -./ Signature of Contractor �/j�
Print Name DU QGfO�- Print Name KQ.('..�.1;�..-(.. ..�1..C1 �1... e. l.-L-............
sf an K `
..............................
Swo ubscrib�l�f me Mo-td subscribe o me 20 Zthis Day f C 20 �� ayofNotary Pub c rc
Revised 01.26.10
��r"�e� Notary Public State of Florida Notary Public State of Florida
Robyn L Ritter Robyn L Ritter
N ,yam My Commission EE 834348 y� �g� My Commission EE 834348
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