354 1st St. (vault) (4) CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
�} ATLANTIC BEACH, FLORIDA 32233
INSPECTION PHONE LINE 247 -5826
Application Number . . . . . 03- 00026339 Date 6/20/03
Property Address . . . . . . 354 360 1ST ST
Tenant nbr, name . . . . RE ROOF,FIBERGLASS SHINGL
Application description . . . ROOF
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 5000
Owner Contractor
------------------------
------------------------
NELSON, MILISSA LEWIS WESLEY TAYLOR
RT.1 BOX 1237 1468 CLASSIC OAK COURT
CLARKESVILLE GA 30523 -980 PO BOX 350103
(904) 249 -3037 JACKSONVILLE FL 32225
(904) 642 -4760
---------------------------------------------
Permit ROOF PERMIT
Additional desc . .
Permit Fee . . . . 83.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 5000
Fee summary Charged Paid Credited Due
-- ---- - - - - -- ---- - - - - -- ---- - - - - -- ---- - - - - --
Permit Fee Total 83.00 83.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 83.00 83.00 .00 .00
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 CONSTRUCTION LIEN LAW CAN
RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS" ISSUED ACCORDING TO APPROVED PLANS
WHIC ARE PART OF THIS PERMIT SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW.
BUILDING OFFICIAL
RECEIVED
CITY C?�
AT v , � [jFA-
J BU1'LDiNG & Z0VNG
CITY OF ATLANTIC BEACH
ROOFING PERMIT APPLICATION JUN 19 2003
DateY A
.... .......... __._ - - -.
Job Address: S q-3
Owner of Property: , 0 /// 211 . 5/x, ,Ve l jvv
Address: 3 2 `7 S 7 ke Telephone: Z Y 9 -r037
Contractor: Al e w I'$ [A State License Number: NCO D `f Z.5'/ 3
Contractor's Address: 1136 'L Avj C,&eej,- Qj, Zl/
Telephone: 1 1 (o-t� 1-,' 6 a Fax:
Scope of Work: )e - R a aF w ;'CA �hv� � lr+ SS 54 1,9/e -s
Deck Slope: 3417, C Greater than 2:12 Less than 2:12
Valuation of work: -f01)0
Product Name (Example: Timberline): G'r�� wti.7i.y�/L 2d
Manufacturer (Example: GAF):
ASTM Designation(s):
Required Inspections: -Sheathing and Firi
Signature of Owner: -- Date:
Signature of Contractor: 'S. �� /d� Date: y Ds
AS TO OWNER:
Sworn to and subscribed before me this Q day of 20 M-3
State of Florida, County of Duval
Notary's S' ature:
Personally known ya, CA Batdrich
❑ Produced identific on * fa ** C ommissioneco4ml
Type of identifi tion produced 3 ''p Expires August 00
t20 24
AS TO CONTRACTOR:
Sworn to and subscribed before me this
day of ' 20 63
.
State of Florida, _ County of Duval /
DEBRA A.KELLER Notary's Signature (
MY COMMISSION # CC 883424
EXPIRES: October 27, 2003 Personally known
Bonded Thru Notary Public Underwriters
Produced identification
Type of identification produced f �—
800 Seminole Road • Atlantic Beach, Florida 32233 -5445
Telephone: (904) 247 -5800 • Fax: (904) 247 -5845 • http : / /www.ci.atiantic- beach.fl.us
Page 1 Revised 2!21/03
Book. 11164 Page 420
$oc : 116497196
Pa e: 420
Filed 6 Recorded
06/20/2003 09:55:26 AM
JIM FULLER
CLERK CIRCUIT COURT
DUVAL COUNTY
RECORDING $ 5.00
TRUST FUND f 1.00
g MIN. RETURN
PHONE #
NOTICE OF COMMENCEMENT
State of - Kb <-A Q'P Tax Folio No. I q 7 q 7' L �� b
County o mM
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 CO141MENCEENA NT.
L al desc iption of pro erty Bing improve : / � -7� �(-�1 j9
Address of property being i_rnproved: - s - V-- 3t v r�TX its i is �
General description of improvements: _ ov r� dtie t% /,, s lie/ •�.
2. D L
Owner: </
Address: z 7"* 7
Owner's interest in site of the improvement: vD
Fee Simple Titleholder (ifo er ban owner):
Name: sa,-
Address:
Contractor:
Address: z
Phone No: f''i�/ Gs%s r sr�p Fax No:
Surety (if any):
Address: Amount of Bond S
Phone No: Fax No:
Name and address of any person making a loan for the construction of the improvements.
Name: /V14
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:
Phone 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 option). --
Name:
Address:
Phone No: Fax No:
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