Permit Roof 146 W 14th St 2013 CITY OF ATLANTIC BEACH
s 800 SEMINOLE ROAD
J = ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
. F
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Application Number . . . . . 13-00002006 Date 1/16/13
Property Address . . . . . . 146 W 14TH 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
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BENNETT THOMAS J JUSTIN LARSEN CONSTRUCTION INC
385 5TH STREET PO BOX 1942
ATLANTIC BEACH FL 32233 4784 CATTAIL ST
MIDDLEBURG FL 32068
(904) 241-0320
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 70 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 4000
Expiration Date . . 7/15/13
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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
7/t/e /77 T
Job Address: 'SPC 06 ZZ 3 3 Permit Number:
Legal Description /7-Z S ZyC J�W // 1X*"MFe#Parcel#
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ -'/0-7 - Proposed Work heated/cooled non-heated/cooled
Or c.es{
Class of Work(circle one): New 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 sprinkler system 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: /2Et!!�100X
Property Owner Information:
Name: Address: ��
City / TIC /3el✓)-Cll - State/--'Zip 32 Z S, Phone
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: ��ICG U/GU/>ti('S�, a-U—,/ *X'---.f1/'4 6ualifyingg Agent:
TW /'y �'"/�f")
Address: kt City rK /" E� ' State i Zip 3 Zz)3
Office Phone 'C) - Z -'Cz2 G Job Site/Contact Number ( - t-Mr-0904 Fax# �dj;�-G47-C;
State Certification/Registration# CeC 1'2 S" C 2/2-
Architect
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void of work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six 16)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing,Signs, Wells, Pools, urnaces, Boilers, Heaters,
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 BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereby cert that 1 have read and examined this application and know the same to be true and correct. All provisions of laws rdinances governing this
type o work will be complied with whether sped eed herein or not. The granting of a permit does not pres a to give a or' to violate or cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction.
Signature of Owner Signature of Contract r
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Print Name .J /g��i„%C7/ Print Na e WAD /Q. �J CG
�5 5
................. ...... .............................................................................................. ................................................................. ..............................................................
Sworn to and subscribed before me Sworn to and subscribed before me
this�Day of J/q.t/i c f 20l _ POPE this Day of�,-,� wu„nu, ona6(3
�� Notary Public,State of Florida /� / ®' Notary Public,State of Florida
comm, vot.1 1,201`"Notary Public �p •` "--- 9� �MG
Notary Public Y 'r"`P'�"'�"c '
Commission No.EE 128745 ryCommission No.EE 126746
Revised 01.26.10
Doc#201 301 41 08,OR 8K 16219 Page 23,
NOTICE OF COMMENCEMENT Number Pages:1
Recorded 01/16/2013 at 11:25 AM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
Permit No. RECORDING$10.00
Tax Folio No.
T11f; t 1NDF.RSIGNE'D hereby gives notice that improvements will he made to certain real property,and in accordance with Section
713.11 of the Florida Statutes,the f'ollowinv information is provided in this NOTICE OF COMMENCEMENT.
I.I)escription of property (legal description): ( 7- 5 a,g
a)Streit(job)Address: i L/(p�IY�
2.General description of improvements: ` G" 1 C LSC 1l'�G'EJ`�
3.Owner Information
a)Name and address:—r4wmas .1Q,t/IQJ _ :�j J-`�"}" .1/1 C. (��G ��-
b)Name and address of fee simple titleholder(if other than owner)
cInterest In property �7n-Q�-- -
4.Contractor Information
a)Name and address: ��w
tJt'J b
b)Telephone No.: �0 �Q
P `� 2�(_ 4 3 Fax o.((Opt.) � a
5..'ure(y Information
-
a)Name and address:
Amount of Bond:
c)'1'elephone No.: Fax No.(Opt.)
a)Name and address:
Phone No.
7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a)Name and address:
b)Telsphone No.: Fax No.(Opt.) _
8.111 addition t�himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b),Florida Statutes:
a)Name and address:
b)'I`elephone No.:— Fax No. (Opt.)
xplration date of Notice of Commencement(the expiration date is one year from the date of recording unless N different date
is specifled):
WARNING TO OWNER: ANY PAYMENTS MADE; BY THE OWNER AFTF,R THF.EXI11RATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS IINDER CHAPTER 713,PART 1,SECTION 713.13,
FLORIDA STATUTES,AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVF;MENTS TO YOUR PROPERTY.
A NOTICE OF COMMENCEMENT Mi IC'r RF.RECORDED AND POSTED ON T11P,JOB SITV HIKFORF.TNF.FIRS'r
INSPECTION. Ih YOII INTEND TO OBTAIN lei NAN(.ING,CONSULT YOUR LFNDFR OR AN A7"1'ORNE V BEFORE
COMMENCINt,WORK OR RI,1`0140IN(, YOUR NOT1C1,(Ne COMMFNC1eMF,NT.
SI ATV OF MLORIDA
('OUN'rY OF VINM:LLAS 10
5ignalurc n )wlkr or Ow+x;1&At, ii�x icer/Dirw:Wr/PmUtcl/Ma+tagcr
Print Nano.
The forckoing instrument was acknowledged before me this 1`.�day of > ert,llr�i-(,1' 20 13,by
as (tyke/ of authority,e.g. officer,trustee,
attorney in feel) for (name orparty oil behxiro("110111/instrument was executed).
f i OR Pioduced Identification Notary Signature //moi
I'ypc of Identification Pratucud Name(print) f t((,eta
t)IZ _ L WILLIAM L.POPE
Notary Public,State of Florida
Verification pursuant to Section 92.525, f lorida StHfutcs. Under penhllics of pci jiry, I deulhlc llud 111h\( rc,l Nota(�)�p�Stat of Fl 6da
the facts stated in it ar(-true to the Inst of my knowlcdpr and hrlirf. 2045
Commission r69 EE 128745
I 11N M�.'!Vf H i."211111
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