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CITY OF A T LN T 1 C E EA C H
ROOFING PERMIT APPLICATION
JOB LOCATION: 33 • Zc
OWNER OF PROPERTY:_ SCo 7 I ee (s
CONTRACTOR: Dr`b bie 406'" (.,
CONTRACTOR'S ADDRESS: 3S•77/S
_ f(4 . zip: 3 )) / 7
STATE LICENSE NUMBER: 'lam COO 3 Sr.3 53 TEL E.F!-1C N E. 7.?/1 31-
DESCRIBE WORK TO BE PERFORMED: kc' cr 6/
VALUATION OF FROFOSEO CONSTRUCTION cRiO0/°a
MATERIALS-70 BE USED: 3 • V- feet)4 c roe .-11/
SIGNATURE CF OWNER: _ J' �� ,—•%
•
SIGNATURE OF CONTRACTOR:. ‘,67
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S'vlCRN TO AND SIJESCRIEEE BEFORE ME T HS OAY OF a '9 9,
NOS, PUBLIC
Li2tiiity Insurance Supplied "' ROBERT J.BEAN
MY COMMISSION#CC 579790
Wcrkers Ccmpensaticn Insurance Supplied / ; `=:-zr
• ` EXPIRES:October 23,2000
•„Rf
Bonded Thar Notary Public Underwriters
Contractor License Infcrmatien Supplied
Occucaticnal License Infcrmation Supplied
? CITY OF ATLANTIC BEACH
DEPARTMENT OF BUILDING
800 Seminole Road -Atlantic Beach, Fl 32233 -Tel. (904) 247-5826
ROOFING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 18434 Address: 336 SEMINOLE ROAD
Permit Type: RE-ROOF ATLANTIC BEACH, FL 32233
Class of Work: ALTERATION Township: Range: Book:
Proposed Use: SINGLE FAMILY Lot(s): Block: Section:
Square Feet: Subdivision: SALTAIR
Est. Value: 2,300.00 Parcel Number:
Improv. Cost: 2,300.00 _ OWNER INFORMATION
Date Issued: 6/29/1999 Name: LEEMIS
Total Fees: 25.00 Address: 366 SEMINOLE ROAD
Amount Paid: 25.00 ATLANTIC BEACH, FLORIDA 32233
Date Paid: 6/29/1999 Phone: (904)249-9061
Work Desc: REROOF
CONTRACT OR(S) APPUICA`IION-°FEES
•
DIBBLE ROOFING COMPANY RE-ROOF 25.00
Inspections Required
NOTICE - INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION
BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE, AND
MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER
"FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY
OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS"
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION
FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW.
// / $25.8814
", f /iL Date: 6/23/94 91 Receipt: 886811
Cl '�OF ATLA C BEACH Ei010868+ 2Elna