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Permit Roof 566 Clippership Ln 2013 r f � CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 13-00001964 Date 1/08/13 Property Address . . . . . . 566 CLIPPERSHIP LN Application type description ROOF PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 6394 ---------------------------------------------------------------------------- Application desc reroof ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ KOENIG, DONALD M. K & D ROOFING & CONSTRUCTION 566 CLIPPERSHIP LANE 2758 DAWN RD SUITE 1NE ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32207 (904) 553-1381 ---------------------------------------------------------------------------- Permit . . . . . . ROOF PERMIT Additional desc . . Permit Fee . . . . 85 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 6394 Expiration Date . . 7/07/13 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 85 . 00 85 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 89 . 00 89 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. j A A--R'` 10- CITY 0-CITY OF ATLANTIC BEACH ROOFING PERMIT APPLICATION Date: j © /' � C �-CSC I� Job Address:_ �" -�-- Owner of Property: 2— Address: 5M-7�1,L- `f"�� Telephone: Roof Contractor: e,-Z4 tate License Number: C_ Contractor's Address: Q_ X_J A Telephone:q Cs!Zf 5!�Zz ` (((� Fax: Email: Scope of Work: Roofing Material. FL Product Approval# l � l Valuation of Work: Required Inspections: Sheathing/In Progress-Dry In /Final If re-roof: Assessed Value of Structure:_<$300,000/_>$300,000;Roof-to-wall improvements required? (Applies to single family structures only) "WARNING TO OWNER: YOUR FAILURE TO RECORD NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEYBEFO RECORDING YOUR NOTICE OF COMMENCEMENT" SIGNATURE OF OWNER: Date: Z AS TO OWNER: j'� Sworn to and subscribed before me this day of �re of Florida,County of Duval DATNA A. DEUBLER Notary's Signature: ( 1 ) 0 t.r� ' *Personally known Notary Public, State of Ohio 0 Produced identification My Commission Expires Sept 13,2014 Type of identification produced SIGNATURE OF CONTRACTOR: - Date: AS TO CONTRACTOR: Sworn to and subscribed before me this day of 20 State of Florida,County of Duval Notary's Sign Lure• �-- rsonally known DATHA A. DEUBLER [I Pro uced identification Type of identification produced Notary Public, State of Ohio MV Commission Expires Sept 13.2014 800 Seminole Road Atlantic Beach,Florida 32233-5445 Telephone: (904)247-5800-Fax:(904)247-5845 F:\roof permit applicaton 2010 NOTICE OF COMMENCEMENT State of Florida.Countv of Dim-)I THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with Chapter 713,Florida Statutes,the following information is provided in this Notice of CommencemimL 1. Deserintionotpropel- - —.1--intinnrif 4C::� ( 7 r - nr Usiru Shin jt'S 3. CAvner fnformation, -j n.-,,anie amu Add ress:�-17��.; o)Interest in property: —T— )Name and address of simple titleholder(if other man owner.): 4. Contractor Information. -11) a)Name and AddrCsy.t4f� poopinq A-M I)a b)Phone Number: 01 GH-�;Lfl-1-100 J W 6 7 3,20 5. Surety Information: 'Doc#2013005950, OR BK 116209 Page 932, Name and Address: 1`4urnber Pages: I b)Phone Number. Recorded 01/08112013 at 02:40 PM, Amount of Bond:S Ronnie Fussell CLERK'CIRCUIT COURT DUVAL COUNTY 6. Lender Information: RECORDING$1000 a)Name and Address: b)Phone Number. 7. Person within the State of Fiorida designated by o,%mer upon whom notices or other documents may be served as provided by 713.13(])(a)7,Florida Statutes: a)Name and Address: b)Phone Numbers of Designated Person: 8. In addition to himself/herself,Owner designates of to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes. a)Name and Address: b)Phone Number of person or entity designated by owner: 9 Expiration date of Notice of Commencement(The expiration date is one(1)year from the date of Recording unless a different date is specified: WARNING TO OWNER- ANY PAYjXffi'NTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART I, SECTION 713.13• FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION.IF YOU INTEND TO OBTAIN FfNANCINIG, CONSULT WITH YOUR LENDER OR ANT ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOURNTOTIC COINfIVIENCEMENT. )Signature of Mvner or C ized Officer/Director/Partner/lvlanager Sighatory's Printed Name&Title/Office The foregoing instrument was acknowledged before me this day of t-\ 2C-_Z_,by as for (Name of Person) (Authority Type:i.e.Officer/Anomiky) (Name of Party Instrument!�Executed for) DATHA A. DEUBLER Not-jr,public, State of Ohio NOTARY PUBLIC.STATE OF FLORIDA IV Commission PrintExpires SePt 13,2054 Name: rsonaUy Known entification/Type: Verification pursuant to Section 92.525,Florida Statutes.Under penalties of perjury,I declare that I have read the foregoing and that the facts stated in it are true to the best of my knowledge and belief Signature of Natural Person Signing Above Revised 10/1/2009