1679 SEMINOLE 03 ROOF PERMIT CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
oil
Application Number . . . . . 13-00002541 Date 4/24/13
Property Address . . . . . . 1679 SEMINOLE RD 03
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 4000
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Application desc
REROOF
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Owner Contractor
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CAREY, STEVEN EDWARD GREAT WHITE CONSTRUCTION INC
1679 SEMINOLE RD APT 3 4320 DEERWOOD LAKE PWY
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32216
(904) 838-1659
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 70 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 4000
Expiration Date . . 10/21/13
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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 70 . 00 70 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 74 . 00 74 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Pennit No. Tax Folio No.
State of County of
To whom it may concem:
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
COMMENCEMENT.
Legal description of property being improved: (/A,,4 2- +61.A ,44 j2v_� 1c;
C
& -_e FL
Address of property being improved: Sol_ 4-71 ".7— Z
FL
General description of improvements:
Owner Lj -Tc, 4;6-
LC�5-
Address 67
Owners interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor
474 tile
'I'00"
Address
---,Phone No. Fax No. 7X 11,W7
Surety(if any)
0'
dress— 4±� Amount of bond$
Phone No. f Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name 114
Address ?ff1' 4
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 4
Address 044Z 4
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 Statutes.(Fill in at Owner's option).
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDEWS USE ONLY Signed: ER DATE y/1
Before me this_day of �ie
— — — — County of Duval,State of Florida,has personally appeared
JAYSON DACKS herein by
himself/herself and affirms that all statements and declarations herein
are true and accurate
ar 11
Not y Pub c - State of Florida
My Comm Expires Oct 7.2014
Commjs�ion # EE 33207
OF F,
Boridel Tniougn National Nolary Assn]
NotaiS-Public;ptlaw,State W—j Counyf
Doc#2013101712,OR EIK 16340 Page 1858, A$Komn sal6ifexpires: Zd 'Z�Z 4 'n-/
r'Personally Known or
Number Pages:I Produced Identification 77 7
Recorded 04/2412013 at 12:09 PM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING$10.00
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 14 7 �F s2m//-V/,," 'S Permit Number:
Legal Description Floor Area of 9—q.Tt—. Parcel 4_—Sq.Ft
Valuation of Work$ noo Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) circle one): Commercial Residential
If an existing structure,is a fire spriler system installed? (Circle.one): Yes No N/A
Florida Product Approval# 100-LA-t(o
For multiple products use product app
Describe in detail the type of work to be performed: rc_vloo
Property Owner Information: Address: Upli 03
Name: J"' I_WC- A 4F . Cq!��_M
City 4-h_4,2ne, S1,n4jAIE Statek Zip 3_2Z_13 Phone Z-ql- 5,7 r Z_
E-Mail or Fax# (optional)
Contractor Information:
Company Name: GyccA WV,�:%N'- Qualifying Agent: V7UT_%,t k UVW
Address: LU3..,o City -TLy State C-L- zipja4a-v,
OfficePhone 904 �(2i-KSS Job Site/Contact Number Fax
State Certification/Registration# CC,(. (250tciL)17
Architect Name&Phone#
Engineer's Name&Phone
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
4pplication is hereby 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 permit and that all work will be performed to meet the standards of all laws regulating construction in thisjurisdiction. This permit becomes null
six fter
and void ff work is not commenced within six(6)months, or if construction or work is suspended or abandonedfor a period of �6
)months at any time a
work is commenced. I understand that separate permits must be securedfor Electricar Work,Plumbing,Signs, Wells,Pools, urnaces,Boilers,Heaters,
Tanks andAir Conditioners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING9 CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
lhere �certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
oTb
type. .work will be complied with whether ecified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any otherfederal,state, or local"f1w r lating construction or the peTformance of construction.
Signature of Own Signature of Contractor
Print Name TtVL)-,d Print Name
....... ....... ...................................................................
......... ......I................................
....................................................................................... .
Befor Bef e 20
this Day 20 D of
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wy U 776
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3onded Th otary b1cU'
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Revised 10.24.12
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