1365 SEminole Rd (vault) PAGE
INSPECTION TICKET DATE 9/04/03
PREPARED 9/04/03, 8:20:28 INSPECTOR: LARRY i HIGGINS ------------------
CITY OF ATLANTIC BEACH ----------------------------------------
-------------------------------------- SUBDIV:
ADDRESS . : 1365 SEMINOLE RD
TENANT, NBR: RE-ROOF OWENS CLASSIC20YR PHONE (904) 744-8888
CONTRACTOR ARLINGTON BEACHES ROOFIN PHONE
HACKNEY, DAVID
OWNER
PARCEL 171898-0000 ----------------
APPL NUMBER: 03-00026694 ROOF ------------------------------------------
---------------------------
pERMIT: ROOF 00 ROOF pERMIT
REQUESTED INSP DE CRIPTION
TYP/SQ COMPLETED RESULT RE ULTS/COMMENTS-------- -----------------
---------------------------- SHEATHING TIME: 08:00
/04/03 LJH '�Aw
17 01 144-8888 -----------------------------
COMMENTS AND NOTES ---------
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FLORIDA 32233
INSPECTION PHONE LINE 247-5826
I'D
I D
Application Number . . . . . 03-00026694 Date 8/20/03
Property Address . . . . . . 1365 SEMINOLE RD
Tenant nbr, name . . . . . . RE-ROOF OWENS CLASSIC20YR
Application description . . . ROOF
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 3750
Owner Contractor
------------------------ ------------------------
HACKNEY, DAVID ARLINGTON BEACHES ROOFING
1365 SEMINOLE ROAD 1441 CESERY TERRACE
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32211
(904) 744-8888
----------------------------------------------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 98 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 3750
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 98 . 00 98 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 98 . 00 98 . 00 . 00 . 00
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 TIES PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW.
BUILDING OFFICIAL
09/19/2003 09:54 9047450000 ARL BCHS ROOFING PAGE 02
CITY OF ATLANTIC BEACH AUG 19 2003
ROOFING PERMIT APPLICATION
Date:
1365 seninole road
C)wwot'Propaty: DAVID HACKNEY
Addren: P.O. BOX 1258 FOLLY BEACH, S.C. Telephone-.
Con(f3cor.- ARLINGTON BEACHES ROOFING Sw4;Lk%wAcNwmb-,.-r: CCC1325530
Contrwor'3AWF"s'. 1441 CPSERY TERRACR JbV.K90NV1LL9,FL. 32211
Telephone-. 744-8888 p&,g; 745-0000
scqxorwork.EL-_ �C&J� '. 25 So. SHINGLES
Dc4k Slopu, )( .- - - —Greatair than 21:12 —Less ftn 2:12.
v3ivationawork: 1 3750-00
product Name(C;wmplc:Timberline): QLAsgIC 20 YEARSH.
M&Mractuger(Example:CAF): OWENS CORtfING
ASTM Designation(sy_ A ___ A J i
Required Inspectiona. S thin a Final
Sigriature of Owner-
Signature of CE Date-
AS TO OWNER. day of
State of Flondk Couaw of Duval
-1Y
*4k*W commkimi"00aw PWkM*Iiy ~
N..V Epi.hiby 17,20M Prody idaritificatiom
Type of 144mlifimlion prodwccd
AS TO CONTRACTOK'
S%vm to wW subscribed before me this day of 20,Qj
4 of
State off loridj.County of Duval
Notary's
Bob— &Mrowipp, -j
00=76" pe-ol/gly imo
ERPM M'y I?,M P(odd u cm d�i d Ice6o"
Type of iden6ficatice pirodocird
M Seminole Read Atlantic Booth,Florida 322M.SA45
Telephone: (904)247-51104 ftx4. (W)141-5845 -http;//www.cLa1taiP1k-beach.ft.V5
rate I
08/19/2003 09:54 9047450000 ARL BCHS ROOFING PAGE 01
L
FAX COVIM LXTM
ARLINGTON BZAC=S ROOnNG
1441 CZSZRY TZRRACX
JACKSONVILLX, FLORIDA
32211
DATE: TINZ:
TO: FROM:
PBONE:19044/744-8888
FAX 0:004) 74S-0000
CONNEM
TOTAL NUMBER OF PAGES (INCLUDING COVER LETTER) :
NOTE: IF YOU DO NOT RECEIVE ALL PAGES, PLEASE CONTACT US AS
SOON AS POSSIBLE.
5 MIN. RETURN Book 11256 page 1789
744-8888 PHONE #
90-T-I-CI-E OF COMMENCEMNT
(PREPARE IN DUPLICATE) PERMIT
Permit No. Tax Folio No.
State of FLORIDA Countyof DUVAL
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: PCY-1-0)
Address of property being improved: ��' rrA
General description of improvements: RE–ROOF
PREP Owner R\j ) 0 acj�� Q C— I
BY: Address 13(,5- Se ryl I Y-)C J kn
Owner's interest in site of the improvement
Fee Simple Titleholder (if other than owner) N/A
Name m.1 A
Address— N/A
Contractor ARLINGTON BEACHES ROOFING, INC.
Address—14 41 CESERY TERRACE JACKSONVILLE, FLORIDA 32211
Phone No. 744-8888 Fax No. 745-0000
Surety(if any) N/A
Address—N/A Amount of bond $ N/A
Phone No.. N/A Fax No. N/A
Name and address of any person making a loan for the construct.ion of the improvements,
Name N/A
Address N/A
Phone No. N/A Fax No. N/A
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 N/A
Phone No. N/A Fax No. N/A
In addition to himself, owner designates the following person to receive a copy of the Lienor's NoUce as provided in
Section 713.06 (2) (b), Florida Statutes, (Fill in at Owners option).
Name N/A
Address N I A
Phone No. N/A Fax No. N/A
Expiration date of Notice of Commencement (the expiration date is one (1) year from the date of recording unless a
different date is specified): N/A I f
Cc:
CITY OF ATLANTIC BEACH ;F
L.:H i�ns
BUILDING / ZONING DEPARTMENT iogeg
oe
800 Seminole Road
Atlantic Beach,Florida 32233
-5800
(904)247
(904)247-5845 Fax
PLAN REVIEW COMMENTS
Permit Application # 03 - 2-Le Ce
Property Address: - /3L0'S 'Se-ryllrac ( p RA
Applicant: c it A� 41CC,ir L--1 20 AN 4-Y I
Project: ron -e
�'J
This permit application has been:
E2' Approved
Reviewed and the following items need attention:
Please re-submit your application when these items have been completed.
Reviewed By: Uk� Date: 0; - � � "
CITY OF ATLANTIC BEACH PERMIT ..CALCULA-T ION SHFET
Address
D-a t e
Heated Square Footage @ per sq t ..=
ft
C arpart/parch mer sq ft S
7
ID e C'k zer SC f'k:
SC t
TOTAL VALUATION:
Total Valuation Ist
Remaining Value per thousand
tich thereof
: or par i
TOTAL BUILDING FEE
+ -�1/2 Fili.ag . Fee -3
Fireplaces $1.S .00. $7
CA..
PERM-IT FEE
-BUILDING.
RATER. IMPACT FEE
SEWER :IMPACT-�.FEE
VATER' METER/TAP
CAPITAL IMPROVEMENZ
.-SEWER TAP
RADON . (HRS) .005Q '
SECTION H PAVING
HYDRAUL.IC SHARES
CROSS CONNECTION,
SURCHARGE .0050
OTHER
GRAND T OTAL DUE
ADDITIONAL PERHITS OR FE'_ES : ,..1Kechan_J .cal P I unih i ag
Electric/New E I ec t r i c T em p S W i M M_J r.g 0 a
Septic Tank Well
Sign r
Floor Eleval4on
Survey ; .Other
CALCULATIONS and/cr NOTES :
CITY OF ATLANTIC ACH
800 SEMINOLE ROAD
re ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
r
Application Number . . . . . 08-00000385 Date 3/25/08
Property Address . . . . . . 1365 SEMINOLE RD
Application type description MECHANICAL ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
--------------------------- ------------ ---------------- -------------------- -
Application desc
1 cu 1 ahu
---------------- --- ------ ---- --------- ------- ------- ---------!--------
Owner Contractor
------------------------ ------------ ---
HACKNEY THIGPEN HEATING 6je, 'COOLING
1365 SEMINOLE ROAD 2801 DAWN ROAD
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32 07
(904) 448-1962 1
------------------------------- ---- ----------- -------- - ---------------------
Permit . . . . . . MECHANICAL PERMIT
Additional desc . .
Permit Fee . . . . 79 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 9/21/08
---------------------------------------------------------- ------------------
Feesummary Charged Paid Credited Due
----------------- --- ------- ------- - -- ---------- ----------
Permit Fee Total 79 . 00 79 . 00 . 00 . 00
Plan Check Total . 00 . 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.
CITY OF ATLANTIC BEACH
MECHANICAL PERMIT APPLICATION
oil Date:
rProperty Address: \2Sk,15
Owner: Telephone
Telephone
Contractor:
Fax
Contractor Address: -'2-gistm
to perform said work in accordance
In consideration of permit given for doing the work as described in the above statement,we hereby agree
with the attached plans and specifications which are a part hereof and in accordance with the City of Atlantic Beach ordinances and standards of
good practice listed therein.
If other construction is being done on this building
Type of Heating Fuel:
or site,list the building permit number:
1< Electric
Cl Gas: —LP —Natural —Central Utility
• Oil
• Other—Speci N NATURE OF WORK
MECHANICAL EQUIPMENT TO BE INSTALLED
Li Heat —Space _Recessed `��LCentral —Floor 1�1 Residential
• Air Conditioning: Room - ntral
N�ickness 0 Commercial
• Duct System: Material—
• Refrigeration Maximum capacity___---------cfffi Zl New Building
Li Cooling Tower: Capacity gypra Existing Building
Ll Fire Sprinklers:Number of Heads
Ll Elevator: Manlift—Escalator (Number) Replacement of Existing System
1 —— ber)
C) Gasoline Pumps _(Nurn New Installation
Ll Tanks (Number) (No system previously installed)
El LPG Containers (Number)
Ll Unfired Pressure Vessel LI Extension or Add-on to Existing System
0 Boilers
• Gas Piping 0 Other-Specify—
• Other—Specify
LIST ALL EQUIPMENT
AIR CO7, 1UTIONIING,REFRIGERATION EQUIPNIENIT&CONDENSOR'S Approving
Ton's Agency
bel Manufacturer
Num r nits Description Model# L
A 4.
ppr
A0
g
Lv
e
i
nn
c
y
HEATING—FURNACES,BOILERS,FIREPLACES&AIR HANDLER'S EApproving
e
Number Units Description Model# Manufacturer BTU's Agency
% LA-T
A % Y )A
TANKS Nominal Capacity Type Liquid Serial —;;�5-1--v-9
How Many &Dimensions Contained Manufacturer No. Agency
800 Seminole Koaa - Atianuc Beach, Florida 32233-5445
Phone: (904)247-5800- Fax: (904)247-5845 - http://Www.ci.atiantic-beach.fl.us
10232
PSR-3844
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
----- PERMIT INFORMATION ---- � LOCATION INFORMATION -------
Permit Number : 10232 Address : 1365 SEMINOLE ROAD
Permit Type: PLUMBING ATLANTIC BEACH , FLORIDA 32233
Class of Work: REPAIR - - -------- LEGAL DESCRIPTION ---------
Constr . Type: N/A Lot : Block: Section:
Proposed Use: SINGLE FAMILY Township: RNG: 0
Dwellings : 0 Code: 0 1 Subdivision:
Estimated Value : $0 .00
Improv. Cost : $0 . 00
Total Fees : $25 .00
Amount Paid: $25 .00
Date Paid: 5/31/95
Wor�
---------- OWNER INFORMATION -- ---- APPLICATION FEES
Name : WILLIAM BERRY PERMIT $25 .00
Address : 1365 SEMINOLE ROAD WATER IMPACT FEE $0 .00
ATLANTIC BEACH, FLORIDA K . 3 SEWER IMPACT FEE 50 .00
WATER METER/TAP $0 .00
7hone : RADON GAS-H .R. S . $0 .00
------- CONTRACTOR INFORMATION RADON CAB 5% $0 .00
Name : ATLANTIC C,�)AST PLUMBING LE CAPITAL IMPROVE . $0 .00
Address : -�23 9TH-AVENUE NORTH SEWER TAP $0 . 00
,jr.,'-KSONVILLE BEACH , FL CROSS CONNECTION $0 .00
License : CFCA2!5'-7'9 Type: 0 SEC H IMPACT FEE $0 .00
CONST. SURCHARGE $0 . 00
SCHARGE/ATL .BCH . $0 .00
NOTES:
PAID
mAY 3 it 1995
r
�jtv ot AtlantiO 5d:
NOTICE—ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURI&
PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE
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 MECHANIC'S LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYINGTWICE FORTHE BUILDING IMPROVEMENTS59
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
sLxj.00 14
ATLANTIC BEACH BUILDING DEPARTMENT rateOOM501MOMI Rcpt: 0057017
1511-11
By: KW6bomlootONTRACTOR COPY
PSR-3844
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
PERMIT INFORMATION ------ -------- LOCATION INFORMATION -------
T-'Ie�mit ' Number ! 10232 Address , 1365 SEMINOLE ROAD
Permit Type: - PLUMBING T�TLANTIC BEACH . FLORIDA 322'
't Work: REPAIR ---------- LEGAL DESCRIPTION -------
'-'iass 0
T Block: Section:
;-On t T pe: N/A
05 e 4 �yj 0
RNG:
Fr se: SINGLE FAMILY Township:
czubdivision:
Dwep�nqjs,�V 0 Code : 0
Estimp;ed alue : MOO
Im ov � Cost : $0 ,00
Total Fees : S2-5 .00
Amount Paid : $25 . 00
Dat#..P-Ajd-- 5/ 31/ 95
OWNER INFORMATION APPLICATION FEES
WILLIAM BERRY PERMIT
1365 SEMINOLE ROAD WATER 1MPAC'T FEE
ATLANTIC BEACH , FLORTr7-k SEWER IMPACT FEE $0 . 00
WATER ,METER/TAP $0 .00
RADON GAS-H � R . S .
`.-NTRT--7-�h INFORMATION RADON CAB 5%
Name ; ATLI�NT.! �' COAST FLUMBIN 14E OAPITAL !MPROVE .
Address : 3 9TH Alv'ENUE NORTH� SEWER TTIP
$0 ,00
jA,,*KS0NVTLT,t BEACH , FL CROSS CONNECTION
LicensP : '7F"--�AnAl Type , SEC H IMPACT FEE
CONST . SURCHARGE
NOTES:
NOTICE—ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING
PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE
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 MECHANIC'S LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYINGTWICE FORTHE BUILDING IMPROVEMENTS93
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
$ej 0() 14
ATLANTIC BEACH BUILDING DEPARTMENT 01011 ("?/3�1 �01 Rcpt: W�017
Date:
By:
-----------
N"TV�'f'Q*'RIN
CITY .OiATLANTMBEACH
APPLICATION.'FOR� FLUHBiNa PERMIT
;OB_�,LOCATION
OWNER OF PROPERTY:
BUILDING CONTRACTOR:
PLUMBING CONTRACTOR
AND ADDRESS:
4.1
cl
ONE NUMBER:
TELiPH' '
0
,... STATE LICENSE N
LDING:
TYPE OF BUI
TYPE OF WORK:
THE FOLLOWING FIXTURES INSTALLED
HOW MANY OF
SHOWERS
SINKS
WATER HEATERS
LAVATORY
DISHWASHERS
BATH TUBS
DISPOSAL$
URINALS
WASHING MACHINE
CLOSETS
SHOWER PANS
FLOOR DRAINS
o,rHzk---
$3 . 50 + $15 . 00
TOTAL FIXTURE COUNT:-.
---------------------------------------------------- --
,C
T BE IN AC'i ITH
INSTALLATION OF PLUMBING AND FIXTURES MUS
THE MOST RECENT EDITION OF THE SOUTHERN STANDARD PLUMBING CODE.
CALL A DAY AHEAD TO SCHEDULE INSPECTIONS ( 904 ) 247-5826
PSR-3844 7691
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
----- PERMIT INFORMATION -------- LOCATION INFORMATION
Permit Number : 7691 Address : 1365 SEMINOLE ROAD
Permit Type: WELL ATLANTIC BEACH , FLORIDA 32233
'lass of Work: NEW --------- LEGAL DESCRIPTION
Lot , Blgck:
,-onstr T6;e! ��?Ej��AME Towns 1p : or,6
ProDos6d e: subdivision:
iweliings : 1 Code: 0
�,stimated Value: $0 .00
Improv . Cost : $0 . 00
Total Fees : $10 .00
Amount PAid! $10 . 00
Dat
T., FOR IRRIGATION PURPOSES ONLY
----- COWNER TNFn.RMATION APPLICATION FEES -----
Name-. BARRY PERMIT $10 .00
Addres' s : SEMINOLE ROAD WATER TMPACT FEE so .o�)
RTLI�NTT - EFACH . FLORIDA 3'22 sEWER IMPACT FEE $0- .C,f
SO � 00
Phone � (904 ` 24LI _8_� ?9 WATER METER/TAP
RADON GAS-H .R. S . 80 . 00
------- CONTRACTOR INFORMATION RADON GAS - 5% $0 . 00
Name, LAN' T41'TLIAMS CAPITAL IMPROVE . SO .00
1- 50 .00
Address ' P -0 , BOX 567 SEWER TAP $0 . 00
ATLt'_.NTIC BEACH HYDRAULIC SHARE
7 CROSS CONNECTION $0 �00
Type An ()n
SEC .H IMPACT FEE ;>, I -
CON- S C OTH ER,
N OTES:
NOTICE —ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING
PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE
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 E
"FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS.99
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW. 1,era or: CRYSTAL __1
Dat Mal
eN2/22/93 00 ReceiPt: 00IN81
ATLANTIC BEACH BUILDING DEPARTMENT Total payment $10.00
By:
FFE $lo.no
APPLICATION FOR WaL PERUT
CITY OF ATIRUIC MACH
PRDP= MER
Na-ne:
__Pay Phone ,-7��—r6ZC�
f
Addressc -'le Zip2KI- L 6
APPLICANf, IF G= THAN M-ER
Nanie: ____Pay Phone
2 zi
Address;
JOB
Address or Location: 1,�3(12
L�gal Description:
Is well to be used for drinking purposes?
Any person, individual, corporation or other entity receiving a permit as
provided in Section 22-40 of the Atlantic Beach Code, and who plans to use
water froTn the permitted well for drinking purposes, m-ist first obtain a
bacteriological test report from the State of Florida Health Department,
furnishing a certified copy thereof to the building departnent of the City of
Atlantic Beach. A certificate of occupancy will not be issued until said
report is an file with the building department.
Department Notes:
I agree to comply with regulations stated herein:
,7
ggriature Date
DEPARTMENT OF BUILDING FOR OFFICE USt ONLY
CITY OF ATLANTIC BEACH, FLORIDA Date
enrit #
----------- P gafi
Fee $
__L
Application for Pernit Valuation $ 5-70
for Misc. Alterations House
and Repairs
DESCRIBE:
erect awnings
(state--�f to repair, alter, add to or move building,
or signs,. etc. ) Div.
Building on: Lot NO. Blk o..
Address uation
Owner' s Name 46:7--
6 1 Z1-
BUILDINGS & OCCUPANCY
Building use - Residential or Business
What Plumbing work to be done?
Size of Present Bldg. Size of Extension
Lot size Material of Roof
No. of stories now after altered
Material of Present Building Material of ExteiAPPW*&D----7,-
PLANS MUST BE SUBMITTED HEREWTA Wectural Co m tt 0
. ......... .
...........................................I ..........
SIGNS
Size classification
(state whether ground ro<7,7'W' 144
banner)
Material of Construction
Illuminated? Type of illumination
(State whether lamps or noon)
Will sign be over public property?
SUBMIT DRAWING SHOWING CONSTRUCTION OF SIGN AND METHOD OF HANGING
WRITE ADDITIONAL INFORMATION BELOW
(For canvas awnings provide dimensioned drawing on reserve side)
IMPORTANT NOTICE-.
In consideration of permit given for doik"ew�' ' as described
in the above statement, we hereby agree to perform said work in
accordance with the attached plans and specifications, which are a
part hereof, and in accordance with the building . regulations of the
City of Atlantic Beach. $outhern Standaro Bu4 ipg Code)
---ye
Signature of Builder or owner,,,
Address 6 Phone
0002991
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
Ao T -322*3*3
A-rt-Af4Txc ----------
Type% it ft ocl r - ------ - LEOAL
"ect-Ion
L.o
BE38 ox work ft ILI
ons�tr. -type-. WOOD Township!
OpOsecy use 1-41"01-E rAnXI-T
code. 0
v ellIngo , vo. 00
IM tIM8LVC% vallue. 00
xmprov. cost . nt)
TO'Lal rees'.
Amoun-L Palo%
'at
e a I cl
W K D 13,. NEW A"D Arrt�JCATXUH PEr
pEtmxT
--------- - OWNEtt 1"-t
"ame 1 mft. PERRY WArr�.jt lnf*ACT 00
I-3f6T5 SEtIjNOLE ROAD �5rweft 1"rAur PEE
Acy ress,- "ETER 00
A-MAN"t" WATER 50-00
ft A D Y-)14 0AE5 -�Po.010
nAnc," 0.%t5 c*o.00
TRAC"r-Icift InMrmATION wATFR TAP I
TAP
ROAD mTVjtAUj_jc, -Ti H A R Z 00
Ad ress' l3nqo Ft,. .322-3.3 -IN.-2;PmT Fee
BEAut 'rype, 0 HIE T rzE tit,
Ll eDs,j ItCO(347:�54'1 YnPAC 00
toTnER
NOTES:
NOTICE —ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING
PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE ND MUST BE
BISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,A
BUILDING MATERIAL,RUB AWAY BY EITHER CONTRACTOR OR OWNER.
CLEARED UP AND HAULED MECHANICS' LIEN LAW CAN RESULT IN
MPLY WITH THE ING IMIDROVEMENTSI-93
"FAILURE TO CO WICE FOR BUILD
THE PROPERTY OWNER PAYING T IT AND SUBJECT TO RE V 1 0 CAj�t I FOR
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERM
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
ATL NT41CACH BUILDIN EPA
By�
CITY OF ATLANTIC BEACH
VERMIT AVVLICATIOV ROOFING
owner(s) ,.
4Z phone.
s
Addres
Lot Block Or unit Subdivision
Contractor: phone'.
1115JIL 6
Iss.
Addre
e jj C%
state License Noo one: r
Describe work to be d
f
Materials to be used:-----
I)ate:—f
Lic,
signature OWNER:
signature CONTRACTOR:
DEPARTME FLORIDA
OF
PROFESSIONAL REGULATION
S R
UCT'ON ]INDUSTRY
ICENSING BOARD
REGISTERED ROOFIMG CONTRACTOR
MO NANA Nip
DEP
AR
t -
N
TA
IE
T
(JNS
L
S
0 T
F
CR
A
U
ET
P
E
R
C
N
1
RE G I S T C R C 0 Ii 0 0 1
A A
M" N NV R T"O"A
MONAHAN THOMAS L
0 V
ROOFING
(IN01V A 14(1 s T M C CONTRACTORS
P T 0
R 1: - MUST M I EET LOCAL L.ICENSIN
EQ. I PRIOR TO CONyR.
NT
L
H H s A 0 THE FEE RE 2U
T Y IN Ai4T AREA
AS PAID THE FEE REQUIRED By CHAPTER 489F s.,
FOR THE YEAR
EXPIR,,,G
JUNE -3(). 199,
81 B ARTINEZ
Ali
GOVERNOR
OVER TINEZ
L A�RG A0KNoZl!qfE�Z&f
SECR ETARY,D-P.R.