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Permit Roof 1358 Beach Ave 2013 CITY OF ATLANTIC BEACH j 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 13-00001963Date 1/08/13 Property Address . . . . 1358 BEACH AVE Application type description ROOF PERMIT Property Zoning . . . . . TO BE UPDATED Application valuation . . . . 5850 ---------------------------------------------------------------------------- Application desc reroof ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ GOELZ JOHN H & PATRICIA SHORE ROOFING COMPANY 1359 BEACH AVE 914 7TH AVENUE SOUTH ATLANTIC BEACH FL 322335731 JACKSONVILLE BEACH FL 32250 (904) 241-8842 ---------------------------------------------------------------------------- Permit . . . . . . ROOF PERMIT Additional desc . . Permit Fee . . . . 80 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 5850 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 80 . 00 80 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 84 . 00 84 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITV OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. NOTICE OF 3M=MCZ10=T " Pan It NaTax FWO No- sh"or � � cm t of To whom S mw cono"M �1�/infOnee you tihst�w16 iw ruuads ub ertrtab nsi prepsrgl,sad 81 ftafoa Tf3 d tl�e Flo,lda bis.!ha tom N shaYd loaf Nom of address of property betray irfixowed: usual dascriptiou of bnprovernala - - Oww Addrer c'I f ,c� V owner's mmw t!1 aIle of the improwameM Fee SWI* Of other 0M owns►') Neme Ad&M COtlractOt ``l� .�17v' i" Address PhonsNo. �`(I` iaL FerNo Ad*m Amosutdbond S " Phaue fft FOX Na Nemo era address of any person r oft a teen for lire Nems Address Phone No. Fez No. Named person vAWn go Stab of Flaridk odwt n hknwK desoWed by owner upon whom nObws or otlrer dooianals may be saved: Nems Address Phone Na Fax inti In Odom b Nrneeif,mwd@dSndwgwbkwkV ponos to m*n a oopy of the t tenor's Noce es provkfed in Secddn 713.08(2)(b),Flatds Serbs.(IN In at Owner's option). Name Address Phone Na Farr No. Expiation die of Noflce of Consnarxrnw t tins expMon dab is one(1)yerAom tb dale of recorag unless a tEgS SPMN:POR�S�ONLY " 5 ee irrd ratYs . d dF6ilo,bs arrri�/� �>A Idve�e , oad�a�tae>M�Yloer�sald�lleO,liM[�Ilt a ,Moadmmnh Doc#2013005 06, OR BK 162 Number Pages: 1 09 Page 214, °r ►OF ~x�T—, or Recorded 01%0$/2013 at 12:51 PPA, s ^"- = - Ronnie Fussell CLERK CIRCUIT COURT DUVAL � COUNTY MARJORIE M.ADAMS-MARFNtP RECORDING$10.00 t Y NOTARY PUBLIC STATE OF FLORIDA _- Comm#D00933778 ��ce Expires 10/30/2013 -' ' al 09- CITY OF ATLANTIC BEACH /! r ROOFING PERMIT APPLICATION Date- a Job Address: /-3:N U f 4 ZA OwrreroYPropertv: t) N oG e 1Z -77 l 3 �S 64r,Gh �'� Telephone: 40 . L��> , Address: pp Roof Wntractor. h U�( I�UU'r�'�I CC" State License Number. g L Contractor's Address: !'/ 7'�� fiy( )�`�X /�T iG I"'1 22�C Telephone: 2,41 "? Ll t . Fair: r�/(/'� �3 Emaik Scope of Work: A"(, k0DF (� V AS C _ Roofing Material n c%U FL Product Approval# 56'fid /),a- N St t GIT_Valuation of Work 5 Required Inspections: Sheathing/in Progress-Dry in /Final If m roof: Assessed Value of Structure:Z- $300.000/>$3WAW,Roof-toglimil Imp (Applies to*We family,suucdrres only) "WARNING TO OWNER: YOUR FAILURE TO RECORD NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR/MPROVEMENIS TV YOUR PROPERTY.A NOTICE OF COMM©VCEMENT MUST BE RECORDED AND POSTED ON THE J08 SITE BEFORE THE FIRST INSPECTION. W YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEF, RECORD/N R NOTICE OF COMMENCEMENT" SIGNATURE OF OWNER: C/ AS TO OWNER: i yr 615tlife this day of `c� .20�. W ffi i�fa�lclE�of Duval �n STATE OF FLORIDA Notary's Signaturei�o L I\a c'-C n to Comm#DD0933778 ❑ Personally known iN El Expires 10/30/2013 '�Produced identification Type of identification producedn� � ----SIGNATURE-OFCONTRACTOR:_. AS TO CONTRACTOR: Sworn to and subscribed before me this ` day of i n .2013 State of Florida,County of Duval Notary's Signature:Ss� �-o-,--- —�� i'�t i � A Au )ifPeisonaily khown v = ❑ Produced identification Type of identification produced MARJORIE M.ADAMS4JARRUp y NO'T'ARY PUBLIC 800 Seminole Road•Atlantic Beach,Florida 32233-5445 STATE OF FLORIDA Telephone: (904)247-5800•Fax:(904)247-5845 R\roof permit apple tondo- 7/28/09 Comm#DD0933778 Expires 10/30/2013 ,�i