342 Skate Rd (vault) CITY OF ATLANTIC BEACH
s 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
ten,. INSPECTION PHONE LINE 247-5826
JF31>�
Application Number . . . . . 08-00000670 Date 5/15/08
Property Address . . . . . . 342 SKATE RD
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 3800
----------------------------------------------------------------------------
Application desc
reroof f1183 . 10
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Owner Contractor
----------
LOVE BUILDERS TRUST, INC
342 SKATE ROAD 2771-29 MONUMENT RD 144
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32225
(904) 568-0929
----------------------------------------------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 41 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 3800
Expiration Date . . 11/11/08
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 41 . 00 41 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 41 . 00 41 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
CITY OF ATLANTIC BEACH o 4
r 800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233
OFFICE:(904)247-5826*FAX NO.:(904)247-5845
BUILDING-DEPT@COAB.US
BUILDING PERMIT APPLICATION DUVAL COUNTY
1.JOB ADDRESS: 2:.VALUATION OF WORK: 3.SQ.FT.UNDER ROOF
C .tIantic Beach, FL 32233
icy, "IL / -, " ,
4.LEGAL DESCRIPTION: 5.CLASS OF WORK: 6.USE OF STRUCTURE:
❑NEW BUILDING ❑DEMOLITION RESIDENTIAL
LOT BLOCK SUB DIVISION ❑ADDITION ❑CONVERTING USE ❑COMMERCIAL
7:DESCRIPTION OF WORK: XLTERATION ❑ACCESSORY BLDG. 8.FIRE SPRINKLER:
n ❑REPAIR ❑POOL/SPA ❑YES ❑N/A
9 V ❑MOVE ❑OTHER ❑NO
PROPERTY OWNER: CONTRACTOR: ARCHITECT I ENGINEER:
9.NAME: 15.COMPA YAME: 23.COMPANY NAME.
VUHT
1 .NAME: 24.LICENSEE NAME:
10.ADDRESS: 17,STA OF FLORIDA LICENSE NO.: 25.STATE OF FLORIDA LICENSE NO.:
-zs18.ADDRESS, 26.ADDRESS:
11.OFFICE PHONE:
T77NO.: 19.OFFICE PHONE: 20.FAX NO.: 27.OFFICE PHONE: 28.FAX NO.:
aq
13.C L 9 `: L 21.CELL PHONE: 29.CELL PHONE:
L -a
14.EMAIL ADDRESS: 22.EMAIL ADDRESS: EMAIL ADDRESS:
zea5
FEE SIMPLE TITLE HOLDER: BONDING COMPANY: MORTGAGE LENDER:
(IF OTHER THAN OWNER)
31.NAME:
33,NAME: 35.NAME:
32.ADDRESS:
34.ADDRESS: 36.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 if work is not commenced within six (6) months, or if construction or work is suspended or
abandoned for a period of six (6) months at any time after work is commenced. I understand that separate permits must be secured for
Electrical Work,Plumbing,Signs,Wells, Pools, Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etc.
OWNER'S AFFIDAVIT- I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning. I will not occupy or use the referenced building or any part therof, until all inspections are finaled and
prior to obtaining a certificate of occupancy or completion issued by the building official,as required by law.
r WARNING TO OWNER: ***
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR.NOT F COMMENCEMENT.
OWNER or AGENT CON RACTO
(If Agent,Power tomay or Agency Letter Required) ualifier 0
i
Signed �l r~
Date:S L)I-f' Signe Date: Q
Before me this day of l the county of Before this day of MA20�in t county of
Duval,State of Florida,has personal ppea d D2,State of Florida,has personally appeared
r •r r r
herin by himself/herself andlifirms that all statements and declarations are herin by himself/herself and affirms that all statements and declarations are
true and accurate. true and accurate.
(' r
Notary Public at Large,State of .County of �V Notary Public at Large,State of r(l County of 4d
�a.
❑,Personally Known ( 11 Personally Known
-a }�roduced Identification- ✓ PProduced Identification-
Notary Signature: l Notary Signature:
�. HARRIETTMORRIS
MY COMMISSION#DD 524901 MICHAEL HAYSE
EXPIRES:March 2,2010 mac Notary Public,State of Florida
Bonded Thru Notary Publir,Underwriters Gommission#DD6291731
�:..a sriaw
COAB FORM BLDG01:REVISED:11/6/2007 My comm.expires Jan.15,2011
o-(? CV,o 6). 10
NOTICE OF COMMENCEMENT
State of lt�-/A. Tax Folio No.
County of - \A-A 1 A
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713 of
the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENTS—
Legal Description of property being improved: _��0 �L_ _ j C�l� )�—A
Address of property being improved _ � -55
General description of improvements: _
Owner.-LA-,9 3 A'r2 L Lr--e Address: '� Dn. 5 u` •� —�`'�SL
Owner's interest in site of the improvement: cl
Fee Simple Titleholder(if other than owner): X
Name. ff
Contractor:
?'(W, Address: �-�11 L�t� �l10 rev)04
Telephone No.: 5��
`p Aja. Fax No:
Surety(if any)
Amount of Rnnr1.P.
Address:
Telephone No: Fax No:_ Doc#2OU8126284,OR RK 14501 Page 1390,
Number Pages: 1
Name and address of any person malting a loan for the construction of the ii J le Fled&RecorULLER ded
CLERK 15i2OO8 at 11:46 AM,
UIT COURT DUVA!
Name: COUNTY
RECORDING$10.00
Address: �—
Phone No: Fax No:
Name of person within the State of Florida, other than himself,designated by owner upon whom notices or other documents may be
served: Name:
Address: d�
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice-as provided in Section
713.06(2)(b),FloridA Statues. (Fill in at Owner's op 'on)
Name: t 'S Z2.Z Ck)
Address: O
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER _ {�
Date: /✓
fore me this�—daC in the�� of uvat,State
HARRIEIT MORRIS.
_
MY COMMISSION#1 DD 524901 Florida,has personally appeared ` .
EXPIRES:March 2,2010
OA
Public at Large,State of Flo .� of
Public Und2rvnters exp \
d; o?•' go J Th u Notary commission fres:
Personally Known: or
Produced Identification ti— -'
ADDENDUM
This plan approved subject to the following provisions being
included in the building:
In hollow masonry unit construction, each unit cell shall
be reinforced with at least one No. 5 bar at all corners;
poured and tamped with concrete; such reinforcing shall be
properly tied into the footing and spandrel beam. All
wood truss rafters---roof construction shall be securely
fastened to the exterior walls with approved hurricane
anchors or clips. Footings shall be continuous monolithic
concrete under exterior r walls, reinforced with two 5/8" deformed
reinforcing rods for one-story buildings and three 5/8"
deformed reinforcing rods for two-story buildings.
Reinforcing rods shall be placed in the lower one-third of
the footings, properly placed and fastened on metal saddles
with wire. Footings shall be 20° wide and 8" thick minimum.
The undersigned hereby certifies that he has read the above and
understands that this addendum takes precedence over any contrary
details of the plans and specifications and agrees to comply with
the intent of this addendum.
APPROVED BYa
CITY of ATLANTIC BEACH ntractor/O r
BUILLDDI ' OF CE
Date 7" / E
By
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APPLICATION FOR 14ATER CUT-Ili
TO THE CITY OF ATLANTIC BEACH:
Application is hereby made for water cut-in
at the following address for . units.
Cut-In charge of
Street No. "3ga- =fs-= �&
Lot � � Block Subdivisions
Ordered by: s a, ,yT� h
OWNER
Mailing Address.-
S J 4- 00
TATE o
ACCOUA T 31-70. ��p
METER 110. DATE, IiTSTALLFD
In4d, 57_16, ;/\/ Cd 1v f ! lv,¢T�,c,
� � � /-e /eC/ �/,,/, � - . i��'a�
CITY
OF ATL
APPLI�Z„IDN AN►,�,IC BEACH
PERMIT F'OR SEER CpNNECTIpNS
NO, -23
LOCATION DATE
LOT NO. STREET
BACK NO.
0wl1ER
TYPE pF ILDI S
MASZ►ER PL
INSPIsC►rED ER
BY
BILLED ---�
ACCP , NO.
CITY OF ATLANTIC BEACH
APPLICATION FOR PLUMBING PERMIT
PERMIT NO. Date : 3
LOCATION; ,3sea Street
LOT NO. /7 BLOCK NO . 2-S S/Dk)o14!&1
OWNER M c��rr�1
MASTER FLUMBER
Bldg.
_
BUILDER OR CONTRACTOR .� . C . /204-,eTb Fermit__No,.
TYPE OF BUILDING
_,L_SI11,1KS 2 LAVATORY / BATH TUBS URINALSZ _CLOSETS
FLOOR DRAINS /_SHOWERS / WATER HEATERS_4r DISH4ASHERS
DISPOSALS OTHER
TOTAL FIXTURES T x:1 , 00
NO WORK MUST BE DONE UNTII A PERMIT HAS BEEN PROCURED
PLANS AND SPECIFICATIONS must show a plan and. description of the
size -.and location of all the soil and vent pipes, and the numbor and
location of all fixtures, (in acoorda.noe with Ordinanae no. 188 of
the City of Atlantic Beach, Florida ) must be shown on back of appli-
cation and be approved by the Plumbing Inspector.
DRA�d PLAN AND SPECIFICATION OF ABOVE PLUMBING ON BACK.
Approved by
Plumbing Inspector
Date
(FOR OFFICE USE ONLY)
ROUGH-IN INSPECTED REMARKS
FINAL INSPECTION: CERTIFICriTE ISSUED :
�-1157—x- s
DEPARTMENT
OF BUILDING
CITY OF ATLANTIC
BEACH, FLORIDA PERMIT No. 3062
PERMIT TO BUILD
THIS PERMIT MUST BE POSTED ON JOB
I Ij. Date
1 Valuation $ Plumbin I9
Fee
t This Permit not valid until above tee has been paid to City Treasurer, and is
This is to certify tha
s abject to revocation for violation
Of a
PPlicable provisions of Lw
J. Francis
DU Uid
I
has Permission
to buil
closets 1 shower
E 1 water heater
Classificationresidence 1 washing machine
Owned by Duval Rom
esne
Inc. !
t Lot 17
House No. Bloc 2 3
According to approved pla0
ns which are
part of this permit
NOTICE—ALL CONCRETE FORMS
AND FOOTINGS MUST BE IN-
SPECTED BEFORE POURING,
PERMIT VOID
AFTER DATSIX MONTHS
-- E
c
OF ISSUE
Z Building material, rubbish and
-4 from this work must not be debris
Public space, and mbe cleared Placed is
and hatiled awa eared nP I
[ 7I-7E? or owner_ Y by either contractor
R. C.
Vo el
FOR OFFICE PERMIT Building Official
USE ONLY NUMBER
DATE
l PLUMBING CONTRACTOR
F
ELECTRICAL
r
FSEWER
WATER
I
I
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a3M3s
1 V 0I a 10313
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i
CITY OF ATLANTIC BEACH
APPLICATION FOR SEWER CONNECTIONS
PERMIT NO. )�3 `� DATE
LOCATION � STREET
LOT NO.�� BLOCK NO.
OWNER f1 � l t'
r C �Tt �f - f -
TYPE OF BUILDING
MASTER PLL ER
INSPECTED _ BY
BILLED
ACCOUNT NO. 3�lc
FOR OFFICUsy ONLY
Date------....--.7...-----Y..19....._..Av
-�
Permit #........................Fee
CITY OF ATLANTIC BEACH
Valuation $------
501 --------- .......................
FLORIDA House #..,_3'�4 ' . ......
...........;?... . ......... . ....
.... ..... ...........37'sO 0.0
. ... .......77!�_
APPLICATION FOR BUILDING PERMIT
......................................................................
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the
building or other structure described. This application is made in compliance and conformity with the Building Ordinance of
the City of Atlantic Beach, Florida, and all provisions of the Laws of the State of Florida, all ordinances of the City of Atlantic
Beach and all rules and regulations of the Building Department of the City of Atlantic Beach, shall be complied with, whether
herein specified or not.
The Contractor or Owner-Builder who has been issued a Building Permit is automatically responsible to ascertain that all sub-
contractors engaged by him are duly licensed in the City of Atlantic Beach,Florida. To prevent delay or embarrasment regard-
ing intermediate or final inspections it is suggested that a list of sub-contractors be submitted to this office so that licenses can
be verified. Date....... -----------------------' 19--_--------
V -_ 0
Owner__,0..u.y_k(------Home-5------------T.,* _��_-----_-----.Address---- ......I.-Telephone No 214-------------
Architect--- ..........................................Address.-.7 -•------.Telephone No._7�Y_7_111_17
ContractorBuilder----- W N --------------------........--------------_--Address-----------------___-------------------------.--Telephone No.---------------_---------
Lot No..---]-'7---------------------------------------Block No.--.( .A/P--�-------Zone-----------------
.,w; r L^_S_--------r--------
----------Z-4- Sub Division-- 9.0
----------- -----...Street---GV- s....T..--Side Betwee-n_.C&__V&..(4_.4 4.--------...........and...... ---------------Sts.
Valuation ..........For what purpose will building be used-----Ke.S_i 1c,-w.Cv_Type of construction-_,OL0s-K.... -_-------
Dimensions of Building---- .....Dimensions of Lot-- ------- ...1.3...........Size of Footings.
Size of Piers- ____'S_ _C_P'71-8-Size of Sills_-___.-__ ----- ...-GTeatest Sill Span in ft.-__---------------------Type Roof.-. L.r..St,
How will Building be Heated?- ..............Will Building be on Solid or Filled Ground?--------5-..ck..J.ck........I........
Size of Ceiling Joists....- -40-97-S------------, Distance on Centers........ -/--I-----------------, Greatest Span----------2--_6--- ------------_ 11
,Z-q- or
Size of Floor Joists---------------------------------------------- Distance on Centers- ------------------------------- Greatest Span-----------------------_--------------_
Size of Rafters------------------------------------------- ---- -----, Distance on Centers. ... --- ---------------------------- Greatest Span-----------........------------. --- )v
This rectangle is to represent the lot.
Locate the building Or buildings in the
right position. Give distance in feet from
all lot-lines and existing buildings.
REAR LOT LINE
Two copies of plans and specifications shall
be submitted with application.
Inspections required.
1. When steel is in place and ready to pour footing.
2. When steel is in place and ready to pour columns and/or lintel.
3. When steel is in place and ready to pour beam. �4
E-4 E.
4. When framing is completed. $ $
5. When rough plumbing is completed,and ready to cover up. W
6. When septic tank drain field or sewer is laid but before it is covered.
7. Electrical inspection by City of Jacksonville.
8. Final inspection.
Note: In case of any rejection,re-inspection MUST be called for after
corrections are made. Ycil 65
FRONT OF LOT
In consideration of permit given for doing the work as described in the above statement, we hereby agree to perform said
work in accordance with the attached plans and specifications, which are a part hereof, and in accordance with the building
regulations of the City of Atlantic Beach.
Signature of Builder-A01iYAK------ Address......
..............
Signature of Owner._h-v. ------- Address................. .........................................................
PSR-3844 16395
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
PERMIT INFORMATION ------- LOCATION INFORMATION
Permit Number, 16395 Address : 342 SKATE ROAD -
Permit Type:MECHANICAL ATLANTIC BEACH , FLORIDA 31.2431
.'lass of Work:ALTERATION -------- LEGAL DESCRIPTION ---------
Constr . Type :WOOD FRAME Block - Lot , Twp ,
Proposed Use: SINGLE FAMILY Section: 0 Subd : Rnq*
Dwellings : ro Subdivision:
Est . Value : 11 . 00
Tmprov . Cort : 0 . 00
Total Fees : 33 .00
Amount Paid: 33 . 00
Paid . 5110E,/ I a9p
I ZPPT,A�"P rnNT)FN4FR ANn ATR IR4 MPT.FP
--- OWNER INFORMATION --------- APPLICATION FEES -- -------
Name* KIM OWEJAN PERMIT
Addr * 3"-' SKATE ROAD
ATLANTIC BEACH . FLORIDA
Phone : . 000 )000-000111
CONTRACTOR INFORMATION ----- -
'dame : ABACO AIR CONDITIONING COMPANY
Addr : 3780-1 KORI ROAD
JACKSONVILLE , FLORIDA 32217
Lie: RM0047513 Exp '
Type: 3
NOTES:
NOTICE - INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION
BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE
CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER
"FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS."
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW. Dd te 0133 M 14
CHECKS j/fj//'j?j Ul Receipt: 89553638
8818988321888 8108
ATLANTIC BEACH BUILDING EP RTMENT
By:
MAY-06-98 10 :30 AM P. 03
Ci(Y OF ATLANTIC BEACH
w7 LwrJ 11C II[AOFr, ifiJ.,
APPLICATION FOR MECHANICAL. PERMIT LAI•L•fN Nvm06
11,0011TAw Applicant lo collirAele all items in seclions I, 11, 111. 11-1 IV.� �T
I. Z S KA RO M P
loC/�TIOIJ
Add,
or Ipf.,lfcl;ny Slrrr„' P.I.nrn 9 �! 1 - :_. .... Aw.l. .....�/.•!. Y/ ��� �v�� _
OUILDING
11. IDENTIFICATION • - To be compleled by all aPlAca,115
In C9^ndereYon .yl rern•,1 �L.n Iqr .jn,n? Ihn .nr1 nI II^,t,;l•!r) in r1.n Alrn.n 1IAIrro-nr ve t.trwl;y Arfr�� 1.. Cg,(q...1 1a;$ .q11 .•, erC^r la^tA
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Ill. GENKAL INFORMATION ;
I1. Type of heet;n•I fv.l: 13.
IS 0111En CONstowerION BEING g0jF 04
So Petfrit 11113 9UILOINO Oft S11E 1
C) Get—Q f.D d Nalwal lJ Cenuet UI;I Iy
Is YES, GIVE NUTAGEn Or CONSI AUCTION
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l.7
IV. MICHA 41CAL KUIFMW4? 10 It INS/ALLf.ONATUnE OF WOI1K
(ine.ide complete Isd Of tetwponenh on beet of IMI forml 111. 101 ii1(!n11A1 V1 I.I cutimIvor 1,11
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L.l Exlen3lon 01 add-011 40 e■1slllld Sy31e111
L) 011101 specify
0 Cool-n0 fe.er: Cepet;fy f)•p�•
0 F:re tprWistu Nvelber of
0 Eleveler Q hAanlill Q Etu4ro► _ t"enAberl THIS SPACE FOR OFFICE USE ONLY
(] Getoffne pyw,p _•-(wvwlberl t11,/esl.edl
Q Fe111t (number) Sernntt
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i
A/R CONUITIUNINC AND illi:1iWERA11UN FUUII'NIENl'
rppaelty Al proflns
Number VaILP Deicrlptlon Itodel Number Manufacturer (Tvrut) - — G
HLATINC - FURNACES, POILMS, FIREMAC£s
�y{ C��olty A�tavfets
l�i:R '. Y.r—\.�,rr ram fW��—a1�— �J�r�t..r��� ��ar�I.�a..Yr a 1• Ir�,f
PSR-3844
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
PERMIT INFORMATION ----
---- LOCATION INFORMATION -----
�42 SKATE ROAD
P e rml i-f T v p c- � RE-_F
ATLANTIC BEACH , FLORIDA 32'
IN EW -4..
---------- LEGAL DESCRIPTION --
Constr . Type : WOOD FRAME Block -: - ----
c-
section
Propo-e
I Ilse : PATIO/DECK 4
Township : RN3
DwellingFt 1 0 :'ubdivision :
��Stima�,-.ed VA,lue : 81790 . Q,- ROYAL PALMS
T r
ti
;, R INFQRMATII--)N --- ---- APPLICATION FEES -
ALLEY ----
PERMI-4, $22-
-AD
�Alft-R 114PA,;T FEE
EA;`H . FLOY-TrA
SEW#.R IMPACT FE9
4 2 41 WATPER METERI/Tt'IF
RAD-1-IN Z5.0 CIO
CO3NTRA:q-TOR
INFORMATION
RAD ONGAS 0
�RARZ ,,RQ
Pr`FISC
APIT-AL IMPROVE. n
SEWER TAP
.HYDRAULIC SHARE
CROSS CONNECTION $0 00
!MPA!7T 'PE yzv
Q
NOTES: . 00
NOTICE —ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING
PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE
BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE
CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER
"FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS.
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
ATLANTIC BEACH BUILDING DEPARTMENT
By:
CITY OF A'T'LANTIC BEACH
t'
PERMIT APPLICATION ROOFING
Owners) =--�/. �d L1 4 J- y — ------ -- ..
Address:: 2, SXR}JL� y? V Phone: -
Lot #— Block or Unit #� Subdivision
Contractor:_ P
Address; 5,10 i gPhone;; 3 9 r? 7
State License No. . 0
Describe work to be done:,
Materials to be used: l..lv/, I—._.��w_
Signature OWNER: Date:
s
"'�A
Signature CONTRACTOR: C
i
I
- I
I
i
CITY OF
ATLANTIC BEACH N2 24471
FLORIDA 19
NAME (/) e
///�
ADDRESS 6 o U
CITY ,3 2-Z!:�2
0
$15.68 74
Date: 5/14/98 81 Receipt: &55517
When Signed, Detect and Numbered, This Becomes an Off0110
s 8 ild8
MAKE CHECKS PAYABLE TO Received Payment
CITY OF ATLANTIC BEACH, FLORIDA TREASURER —