1941 Seminole Rd (vault) P
40 FEB 1 4
CK C_N Q ATLANTIC BEACH
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-ROOFING PERMIT APPLICATION -
JOB LOCATION: 5e- „ 2 J T�
TELEPHONE::
OWNER OF PROPERTY:_(
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CONTRACTOR:
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CONTRACTOR'S ADDRESS:
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TELEPHONE:
STATE LICENSE NUMBER:
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DESCRIBE WORK TO BE PERFORMED: I
VALUATION OF PROPOSED
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NSTRUCTION ` Z U • v
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MATERIALS TO BE USED: 2 f r _
SIGNATURE OF OWNER:
SIGNATURE OF CONTRACTOR:
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EFORE ME THIS--DAY O
JAMES BECC786
MOY�aY COMMISSION
�S OCT 27 G14
NTAG OUGH N ARY PUBL
L0 DA Ap�ANTAGE NOTARY 7
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SWORN TO AND SUBSCRIBED BEFORE ME Tl l
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AS TO CONTRACTOR N ARY
JAMES T. BEECHER t
Liability Insurance Supplied ,,oT,u,,, ConnmwoN all CC786M
Pusuo EXPIRES OCT 27.2002 -
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Workers Compensation Insurance Supplied-----
ADVWAGE NOTARY
Contractor License Information Supplied
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Occupational License Information Supplied -
CITY OF ATLANTIC BEACH
DEPARTMENT OF BUILDING
800 Seminole Road - Atlantic Beach, FI 322 33 - Tel. (904) 247-5826
ROOFING PERM
LOC'ATTONTNFORMATION
PERMIT INFORMATION _;< s, ryc -Address`1-941 SE1Vf1NOCE_ROAD
:1ermifNiimber: 23 8 ATLANTIC BEACH, FLORIDA� 31c2233
Permit Type: RE-ROOF Township: 0 Range: 0
Class of Work: NEW
Lot(s):5B Block: Section:
0
Proposed Use: SINGLE FAMILY Subdivision: BEACHSIDE
Square Feet: Parcel Number:
Est.Value: `OW
4,250.00 NER-INFORMATIOW.
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Improv. Cost: ame: gV11TO:-LUCAS
Date Issued: 2/14/200200 Address: 1941 SEMINOLE ROAD
A 32233
Total Fees: ATLANTIC BEACH, FLORID
Amount Paid: 51.00 Phone: (904)247-5415
Date Paid: 2/15/2002 — - - yl
or c
—e - RERO� PLTCATi�N FEE
C7C)NTRACTOR(B"
ATHAM K_O `CONfPAN
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NOTICE I -
;� r � LIC SPACE, AND
'I9T.NOT B�-P � ., .
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BUILDING MATERIAL~ I 0
MUST BE CLEARED U - r l �� IN THE
"FAILURE TO COMPI< 1NNjNG I ---
PROPERTY OWNER PJNfi D SUBJECT TO REVOCATION
ISSUED ACCO
RDING TO APPR 1tH T �I
FOR VIOLATION OF APPLICABLE P ,
Oper: CHERYLE Type. DC Drawer: 1
Date: 2/28/82 81 Receipt no: 35916
LDIHG 1 $51.88
14 PERMITS-BUI
789675
Trans nueber: $51.88
CA CASH
CITY OF ATLANTIC BEACH