304 4th St (vault) 1106
DEPARTMENT OF BUILDING
CITY OF A NTIC BEACH,
TLA
�dAT I ON INFORMATION
Address, 304 FOURTH STREET
Number 11086
All ILANT I C BEACH. FLORIDA
Type, RE-ROOF
T
kw LEGAL DESCRIP ION
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Esti*ated V�tl,ue
prov. Cost'.
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APPLICATION FEZ$
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PERMIT
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NOTICE--o-'ALL CONCRET-F.F:0,000 AND F001INGS MUST BE
0
: ,PERMITV ID�SIX MONTHS AFTER PATEOF _SPE
G MATERIAL RUBBISH AND DEBRIS.FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SRACE,,.ANDMUST BE
D up AND,HAULED AWAY BY E)THER CONTRACTOR OR OWNER
"VOMP.tj�W&H THE MECHANIVIS JEN' AW CAN' AIEWLT IN
URE"To 4111,
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'YINGTW CE T H I Wl
TIH ROPERTYOWNERPA I FOA E IM RO
OVED PLANS WHICH ARE PART OFTHIS PERMIT AND SUBJECT TO REVOCATION FOR ,
ING:TO,APPRi
ACCORD
ION OF APPLICABLE PROVISIONS OF LAW.
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Ca ACH BUILDING DEPARTMENT
77
CITY OF ATLANTIC BEACH
ROOFING PERMIT APPLICATION
JOB LOCATION : (�>C) 'r
OWNER OF PROPERTY:
CONTRACTOR f-�Q
CONTRACTOR' S ADDRESS:
STATE LICENSE NUMBER: TELEPHONE: Z-1 1 C)
DESCRIBE WORK TO BE PERFORMED:
VALUATION OF PROPOSED CONSTRUCTION
MATERIALS TO BE USED:
SIGNATURE OF OWNER:
SIGNATURE OF CONTRACTOR:
Liability Insurance Supplied
Workers Compensation Insurance Supplied
License Information Supplied