Permit Roof 300 5th St 2013 1-S!•-�'�!r1�,
CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00002131 Date 2/08/13
Property Address . . . . . . 300 5TH ST
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 5000
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Application desc
reroof
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Owner Contractor
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JERNAGAN LOUIS R III & HOPE V JUSTIN LARSEN CONSTRUCTION INC
300 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 . . . . 75 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 5000
Expiration Date . . 8/07/13
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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 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
Job Addr ss: 1i� 65r Gg54- OK /3(� 5-4—'4 51ree Permit Number:
Legal Description 5'-69' /to —Z:?m y*4-- A"�C ",? k& Parcel #
Floor Area o q. t. q.Ft
Valuation of Work$ '" Proposed Work heated/cooled non-heated/cooled
Class of W)rk(circle one): New Addition Alteration3e bj> Move Demolition pool/spa window/door
Use of exis 'ng/proposed structure(s) (circle one): Commercial
If an existi g structure,is a fire sprinkler system installed? (Circle one): Yes No
Florida Pro uct Approval #
For multi le products use product approval orm (�
Describe i detail the type of work to be performed:_ ( — � xj7 —
Property ner Information:
Name: Address: 3
City State -3)
Phone 70Y
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Qualifying A ent: U n
Address: 5 City yV1 State P_Zip
Office Phone 90q 2y�320 Job Site/Contact Number�i7— y3/( —TFax#
State Certification/Registration#
Architect N me&Phone#
Engineer's Name&Phone#
Fee SimpleTitle Holder Name and Address
Bonding Company Name and Address
Mortgage L nder Name and Address
Application is ereby 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 rmit 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 wok 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 and Ait Conditioners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO Y UR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereby certi that I have read and examined this application and know the sante to be true and correct. All provisions of law d ordi es governing this
type o1 work ill be complied with whe er srec:ted herein or not. The granting of a permit does not presume to give rity t i ate or cancel the
provisions of a y other federal,state, o ocal law regulating construction or the performance of construction.
Signature of Ow Signature of Contractor
Print Name t es. .. ........._ 4r�rt.� or�.... Print Namei�h.✓.......(, g,S, ,.........................................................................
Sworn toan subscribed before me Sworn to and subscribed before me
this ;�_ Day of-Ee,,6-.,,a..0 2015 this —S,,Day of feb 3
w4LLTAM L.
'J WILI IAM L POPE �/�c�- ��o Nt ryPublic,State of Florida
Notary PublicNotary Public,State of Florida Notary Public My Comm. pre "off1W I
My Comm.Expires Oct.19,2015 Commission No.EE 128745
Commission No.EE 128745 Revised 01.26.10
NOTICE, UF'('OMMFNC�FMEN�r Number0 Pages-
'OR BK 16248 page 802,
Recorded 02/08/2013 at 10:17 AM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
Pern it No. COUNTY
"I ax olio No,
--- -A.. .._ _�. _ _._ RECORDING$10.00
'I'l IF. UNDERSIGNED hereby gives notice that improvements will be made to certain real property,and in accordance with Section
713. 3 of the Florida Stahrtes,the following information is provided in this NOTI('E OF(Y)MMVNCFMM;N'1'.
I.De cription of property (It-gal devcrt lion):
a)Street(job)Address: 46-D
2.6eneral description of improvements: r'e.
3.Owner Information
a)Name and address-
Lu 1'5 C A09CZ
b)Name and address of fee simple titleholder(if otocr than owner) � _76 C_
1!�' ) c) Interest in property 0 W..)fir—
,
4.Co tractor Information
t a)Name and address:
b)Telephone No,
S.SZtr t_y Information l U3' _ Fax No.(()pt.)
a)Name and address:
b)Amount of Nand:
c)Telephone No.: Fax No. (Opt.)
a)Name and address:
Phone No.
7. Ider tity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a)Name and address:
b)Telephone No.: Fax No.(Opt.)
S.In addit to himself,owner designates
713.113(1)(b),Florida Statutes: the following person to receive a copy of the I.ienor's Notice as provided in Section
a)Name and address:
b)Telephone No.: Fax No.(Opt.)
is Spe i anon date of Notice of Commencement(the expiration date is one year from the date of recording unless a different date
- - —
is spec fled):
WARNING TO OWNER: ANY PAYMENTS MADE, HV THE OWNER AFTER THE EXPIRATION OF THF; NOTICE OF
COMNIENCFMFNT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART 1,SF,C770N 713.13.
FLORI DA STATUTES,AND CAN RESULT IN YOUR PAYING TWI(:F; FOR IMPROVEMENTS TO YOUR PROPIERTY.
A NO 1('.E OF(.,OMMFN('FMFNT Mi IST nu RFC ORDER AND POSTED ON THF JOH SITE HF.FORF'1'NIV, FIRST"
INSPE "17ON. IF VOII INTEND TO OBTAIN FINANCING,CONtiUL'I'YOUR LENDER OR AN ATTORNEY BFIrORF
f*OMNIENCINC)YORK OR REC'ORDING YOUR NOT H'6;OF COMMFN('j?MF,N-1'.
MAI k O 'Y110141 DA
COUNTY OF PINY.I.1,As
Signlux n;of M01 )W1 s yr011ikr/Dir'��IudPelUru/Mal er
'sB
Print Nana•.
421)5 ":Wit^
The fior Koing instrument was acknowlodged before me(his ,<f day of (--,e-tir��, ./ 20 b
as
(type of authority,a.p, officer,trustee,
attorney in NO) for (name of()arty on behalf of-Ahom instrument was executed).
.trnal tsown OR I'toduced Idenlificlilion Notary Signator(
Type of dentitication Produced Nanta(print)
()Il
Vcrificai on pursuant 10 Scctiou 91 125, I lorida lAiilulcs. Under ocna►tics of K•r.'ury, I dck: WaL IAM L P p
the facts tared in it arc true to the hest of my knowlydF c and hrli(f. 1 ► �I b0bilc'State
IcurEuinE;and that
'Y State of Florida
MY Comm,Expires Oct. 19,2015
111NMXNtH ,,,I�nr„ Commission No.EE 128745
5ip,n:rlurc ul NrHurd Prrtinn Sir^i•ip I;.•.li,n.;! lu�:\tan
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