190 16th St roof 2012 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J �r ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 12-00001615 Date 11/01/12
Property Address . . . . . . 190 16TH ST
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 4000
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Application desc
reroof
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Owner Contractor
_ _ _ _ ------------------------
BOLE BRUCE S & KATHERINE E HOMEOWNER BLDG SVCM INC(ROOF)
190 16TH STREET 739 BROOKMONT AVE E
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32211
(907) 322-1054
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Permit . . . . . . ROOF PERMIT
Additional desc . . . 00
Permit Fee . . . . 70 . 00 Plan Check Fee
Issue Date . . . . Valuation . . . . 4000
Expiration Date . . 4/30/13
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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 70 . 00 70 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 74 . 00 74 . 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
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 0 14 fTLI+'�✓ C <�- 3 Z Permit Number:
Legal Description Parcel#
Floor Area of SI
Valuation of Work$ 4U °a/ Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): ew 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 s r.nkler s tem installed? (Circle one): Yes No N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed:
Property Owner Information: /
Name: lie &OAddress:
City AnA�u'rrc 6C Stat-- Zip' _Phone
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: /3 Quali i Agent: �• ���'�
r Y1�11 Y State V C. Zi 2�
Address:7,I tel R&Jo �'� - Ctty p
Office Phone --IQ"I Job Site/Contact—Number-2)Z)Z Z. 5- Fax#77.E (7 fv(r�ii�
State Certification/Registration#__C IC1,
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address --
Mortgage Lender Name and Address c=-�
Application is hereby made to obtain a permit to d6 ino the work and installationsI'a
indicated. 1 certify that no work or installation has commenced prior to the
issuance of a permit and that all work wier
ll be performed to meet the standards lllaws rpegulating construction in this jurisdiction(. This permit becomes null
work isd mmenced. hi
otl understand that separate permits mu t be secon r'ured or
for Electrical WorkdP/umb Plor umbing,Signs,aWells�Pools,XFuinaces,Boilmonths at erstHealetrs,
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 BEFR ENTE RECORDING YOUR NOTICE OF
1 here b certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
type .Pvwork will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state, or local law regulati onstruction or the performance of construction.
Signature of Owner T— 't'� Signature of Contrac
Print Name r7,Q �Q- Print Name AC zx�f�✓Ota .................................
..K �..............................................................................................
Sworn to and subscribe before me Sworn to and subscribe before me
this Day of 20 Z this �Day o b
SUSAN D.LUDaA
te el Florid"
Notary Public 20. '��^ Notary Publ'�c State or Florida tary Public =•. My Comm.Expires Katherine Perry =.;so., r 8glrpprr��"
My Commission EE046'194 •%;;f F��;.R0V1SC[I'V'1.GU.I U
�
'?oF F" Expires 02/0612015
NOTICE OF COMMENCEMENT
State ofCounty ofyU Tax Folio No.
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to 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:
Address of property being improved:
General description of improvements:�L dil C.7 U1>
Owner: Address: /9 10'1-'5`7-t tT.ZC R Ck 3- Z 3 3
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
�J Name:
ontractor: 2 k 4C rz,X-4-eJ _
Address: 7 3!9 /3 R arc, v jo V t - ) • T,4-,- • � /
Telephone No.: 32.2.— 1 Cj Fax No: -2 Z '- 6
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name: _
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:
Address:
Telephone 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 Statues. (Fill in at Owner's option)
Name: -�—
Address:
Telephone 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):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Sign Date: /0 -31- /2--
Before me t s day of e I in the ounty of Duval,State
=o,�"°og Notary Public State of Florida Of Florida,has personally appeared Cl 1
Katherine Perry Personally Known: _ _ or
My Commission EE046194 Produced Identifi • ion: J J f0 S !3 - v. 7 9 /`/
'lE0,fro Expires 02/06/2015 ri -
- - - - - - ary Publ` .
Doc#2012243632,OR BK 16126 Page 1181, commission expires: UL O(o Z
Number Pages:1
Recorded 11;01;2012 at 11:42 AM,
JIM FULLER CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING$10.00