Loading...
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