304 4th St (vault) (2) 110
DEPARTMENT OF BUILDING
I C OF,ATLANTIC BEACH
ITY
FORIMT 'ON ---
-------- N IN
PERMIT iNkRkAt ION, * VCATIO
Address", 504 FOURTH STREET
Number,.,
ATLANTIC BEACH- pL0RIDA, ,32,2_,3
'P,
Pei'mit, Ty e'. RE-ROOF
of Work: -NEW LEGAL DBSCRI,PTION
16 1 ock S,
WOOD FRAME Lot : ection*
Qon tr . Typli�
Tosinshipt
)Pro osed usel SINGLE PAN I LY
Subdivisiow ATLANTIC BEACH
-Dwe I ings- I Cod
Estitated vAllue,T, $2,400 -00
vprov I C
S22.50
Total Pees,*-
t22 -50
�i/28/ 95
Da
0`0'CAtiON frus
PERMIT
:5,22 .
ION
H� STREET WATE IMPACT :FEE
Ad,
FEE
CHI F LOR I D 33
1,07-40q
UA&
P
H ft.5
RADO 'GAS,
RADON AB St
T T Ida 'ON -------
CAPI AL , IMPROVE, 00
d
qKOSS: CONNEC'TION .
ATL BRACA', FL- 32233
9 T yp 0 ,00
e- �Stc H IMPACT, FEE
RCO1,
CONST.SURtHAR6Z
NOTES�
ALL CONCRETE FORMS,AN
NOTICE— 0 FOO*"NGS,MUST'SIE'INSPF.CTSO�BFF,
"PERMIT VOID-SIX,MONTHS AFTER bATE OF ISSUE
TER RUBBISH RK MUST NOT,BE PLACEE)1UPUBLIC$FACE,AND MUST BE
AND�,MIRIS,FROM THIS WO ,
4 MA 01AL211.11_
_CLEAV Eb UO' 1,4014AOLED AVYAy 6,�EITHER,CONTRACTOR OROWNER
A
Ci4m
Co ULT, IN
LAV
',TO COM ,--,,WITH THE M9CHANI Ae 41 ''ARAES
UM' p
ENTS
'IMP
_iRTY,
PAYIN TWICE FO 151�7
TH ATH
pe, EM
SUBJECT TO REVOCATION FOR
ii D AccoRpiNGIro APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND
F APPLtCABL ,
rION 0 E PROVISIONS OF LAW. APPAQ 14
APFT�Ec�I
c
El OWNIQA
0014w
ATJ�A, K'IC BEACH BUILDING DEPARTMENT 000
BY,
If,
BY 6d
CITY OF ATLANTIC BEACH
ROOFING PERMIT APPLICATION
JOB LOCATION : -S
OWNER OF PROPERTY: c
CONTRACTOR fy'�G rN C, C)
CONTRACTOR' S ADDRESS: LA-)O - 3CUbU-, �-
STATE LICENSE NUMBER: TELEPHONE: 0 S c-A
DESCRIBE WORK TO BE PERFORMED:-RCI C-'C, 0 IF r
VALUATION OF PROPOSED CONSTRUCTION I-A C)
MATERIALS TO BE USED: "s
SIGNATURE OF OWNER:
SIGNATURE OF CONTRACTOR:
Liability Insurance Supplied
Workers ComDensation Insurance Supplied
License Information Supplied