522 aquatic Dr 2013 roof CITY OF ATLANTIC BEACH
S
J 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00002077 Date 1/31/13
Property Address . . . . . . 522 AQUATIC DR
Application type description ROOF PERMIT
Property Zoning . . . . . . . PLANNED UNIT DEVELOPMENT
Application valuation . . . . 4541
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Application desc
reroof
-----------------------------------------
Owner Contractor
_ ------------------------
-------------
BALWIN ARLENE D ET AL LEWIS WALKER ROOFING
522 AQUATIC DRIVE P O BOX 554
FLEMING SUSTAN T/C LAKE BUTLER FL 32054
ATLANTIC BEACH FL 322335174 (866) 959-7663
-----------------------------------------
Permit ROOF PERMIT
Additional desc . . . 00
Permit Fee . . . . 75 . 00 Plan Check Fee
Issue Date . . . . Valuation . . . . 4541
Expiration Date . . 7/30/13
---------------------
Other Fees STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
Fee summary Charged Paid Credited Due
----------------- ----------
---------- --
Permit Fee Total 75 . 00 75 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 79 . 00 79 . 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
C_'P"e�rmit Number:
Job Address: �o� aoZ-3
• I aG-a I p UAT C —parcel#
Legal Description o" t
oor�Jy Proposed Work heated/cooled 1 r non-heated/cooled
Valuation of Work S ,��
Re -vZo o F
Class of Work(circle one): New Addition Alteration epair 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 . es o N/A
Florida Product Approval# I OU`1
For multiple products use product approval form 0 (�1Co
Describe in detail the type of work to be performed: �CYUc� S
PAW aQPL_(;_:-fM
Property Owner information-
Address:��� Address:
Nam11./
e p��Phone
City Stater-Zi
E-Mail or Fax#(Optional)
Contractor Information: 1 � `
Company Name: 1 St�►S L 1� n , ualifying Age Zi W1
City State��_. P
Address: Fax#
Office Phone ob Site/Contact Number
State Certification/Registration#
Architect Name&Phone#
Engineer's Name&Phone#
.............
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
ASpQr oona lrermebyanmda at a!work willr t do the
work
meand
installations as indicated I c
dawregula ng that o rut onrk to his insr to the
tallation
onT his percommenced bPctime nulla
is
work is commenced 1 understand that separate permits must be secured for Electrical Work, plumbing,Signs, �tlts,Pools, Furnaces,Boilers,Neaten.,
and void if v�k is rtot commenced within six(6)months, or ijconstruction or work rs sus ended or abandoned fora errod of six(ti)months at any time after
Tasks aad Air Cotiditiouers,etc
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT
IN END UCR7 PAYINOB'T'AIN FINANCING o�1RO�TVI.E wETHS
TO YOUR PROPERTY. IF YOU
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YO R NOTICE OF
COMMENCEMENT.
1 hereobywork w that I!l be complied mplied with examined
t eei dlicatiherein a n��The granting of a pethe same to be tme rmit doesnd cnot presumtetons to ivelaws authority fornances violate gor cancel this
the
type 1
provisions of any other federal,state, or local law regulating construction or the performance of construction.
Signature of Owne � _Iffi L�� — Signature of Contra
�M. ctor
1,. ►�rfs...... Ems....
�Q2— ..:...r,: _t...(1..................
Print Name . ...�G.� .......____......_................._.
Print Name
........ ....
Sworn t d subscribed re me Sworn to and subscribed before me 20 ,S
this am °f 20 is��- ay of
o DEBORAH D ASBELL
0r_.E�,CiRAH D ASBELL = :• MY COMMISSION W&MAi1119 .26.10
MY COMMISSION#EE113212 EXPIRES July 17,2015
EXPIRES July 17.2015396-0153
' • • FlorfdeNdaY`�°Oom (4p�3960153 FIorW�NaeryS�°-
(407)395-0153
Doc # 2013024455, OR BK 16232 Page 1106, Number Pages: 1, Recorded
01/28/2013 at 02=12 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10 .00
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POWER OF ATTORNEY
13 11/13
Da e
I hereby name and appoints
to be my lawful attorney in fact to sign my documents pertaining to permits for the
(Check and complete one of the following.)
® To sign for any and all documents until further notice.
OR
&- To th* pecific jo�for wo to be\performe at:
V � - act
Alternate Key# Section Township Range
Lot Block Subdivision
4SnatureContractor
State of Florida
County of (\ f?
The foregoing instrument was acknowledged before me thisl�—day of ,201Z1
by Lem i S who is personally known to me or has produced
as identification and who did —or did not_take an oath.
SEAL 0k.
(SEAL)
Notary Public (Si e)
Notary Public State of Florida
Barbara A Johnston
y c: My Commission EE075920
OF
'? F%,o Expires 05/06/2015