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Permit Roof 566 Plaza 2013 'rye�,•�.►`lrJ. CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD j ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 J31�f' Application Number . . . . . 13-00002066 Date 1/29/13 Property Address . . . . . . 566 PLAZA Application type description ROOF PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 4000 ---------------------------------------------------------------------------- Application desc reroof ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ HEINE JOHN N & NISSE GOLDBERG JUSTIN LARSEN CONSTRUCTION INC 566 PLAZA PO BOX 1942 ATLANTIC BEACH FL 322334123 4784 CATTAIL ST MIDDLEBURG FL 32068 (904) 241-0320 ---------------------------------------------------------------------------- Permit . . . . . . ROOF PERMIT Additional desc . . Permit Fee . . . . 70 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 4000 Expiration Date . . 7/28/13 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- 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 Job Address: 5�to &zA A4FnJc_ 15aaO_ Permit Number: Legal Description 35—(oParcel # FloorArea of fsa.Ft. Sq.Ft Valuation of Work$ Proposed Work heated/cooled non-heated/cooled i Class of Work(circle one): ew Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposedstructure(s)(circle one): Commercial t Residenti ial If an existing structure, s a fire sprinkler system installed? (Circle one): Yes ..._ o N /A Florida Product Approval # For multiple products use product approval form Describe in detail the type of work to be performed: i t Property Owner Information: Name: Address: �te 7 �4d- c�? act FC,3�a33 City State,GZ Zip32�_Phone E-Mail or Fax#(Optional) Contractor Information: \ Company Name: -�lQualifying gent J�,/5�n Address: City !1/t, gent State ELZip 3 Office Phone 9b Job Site/Contact Number 90cf �7 y , /( Fax# State Certification/Registration# l"GG 13.) l Wj 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 00 b a i n a permit to do the work and installations as indicated. /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 f work is not commenced within six(6)months, or if construction or work is sus ended or abandoned for apertod of six(6)months at any time after work is commenced. I understand that separate permits must be secured for ElectricalpWork, Plumbing,Signs, Wells, Pools, Furnaces,Boi/ers,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 certify that I have read and examined thisp/ication and know the sante to be true and correct. All provisions of laws and ordinances governing this type o work ill be complied with whether specs ted herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other fEF7 uction or the performance of construction. Signature of Owner Signature of Contractor Print Name Print Name _, &.60a.v/ ......�a r�..................................................................... ....................................................................................................... Sworn to and subscribed before me Sworn to and subscribed before me this, f /Day of 201­12 this ?A Day of -3 120131 Notary llublic Notary u�IAM L.POPE WILLIAM L.POPE Notary Public,State of Florida Notary Public,State of Florida Revised O l.26.10 My Comm.Expires Oct.19,2o-15 My Comm.Expires Oct.19,2015 Commission No.EE 128745 Commission No,EE 128745 Permit Number Tax Folio Number NOTICE OF COMMENCEMENT STATE OF FLORIDA COUNTY OF DUVAL THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statutes, the following information is provided in this Notice of Commencement. 1. Description of property (Address): � 6 P 2 _ c j� pct � PC 25�a-? 3 2. General description of improvement: 3. Owner information: 1. Name and Address: J©k,n /k;,# - 6 &7 2. Interest in property: Bwr er- 3. Name and address of fee simple titleholder (other than owner): 4. Contactor's name and address: )U5s /j L, . 4ne4 57'-)a-x 3206 a. Phone number: 196 b. Fax number: O a.4// L) t6 Z 5. Surety Information: a. Name and address: b. Phone Number: c. Fax Number: d. Amount of Bond: 6. :Lender's name and address: a. Name and address: b. Phone Number: 7. Person within the State of Florida designated by owner upon whom notices or other documents maybe served as provided by 713.12(1)(a), Florida Statutes. a. Name and address: b. Phone number: c. Fax number: 3. In addition to himself/herself, owner designates of to receive a copy of the Lienor's Notice as provided in Section 713.12(1)(b), Florida Statutes. 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) Signature of Owner: Ap�