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700 Jasmine St 2013 Roof CITY OF ATLANTIC BEACH f 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 13-00003034 Date 7/10/13 Property Address . . . . . . 700 JASMINE ST Application type description ROOF PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 1450 ---------------------------------------------------------------------------- Application desc INSTALL NEW MODIFIED ASPHALT ROOF SYSTEM ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ MAYHEW JEFFERY BRC HIGH TECH ROOF DIVISION 4770 VON KARMAN AVE 6372 GREENLAND ST STE 6 NEWPORT BEACH CA 926602123 JACKSONVILLE FL 32258 ---------------------------------------------------------------------------- Permit ROOF PERMIT Additional desc . . Permit Fee . . . . 60 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 1450 Expiration Date . . 1/06/14 ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 60 . 00 60 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 64 . 00 64 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. tszg nom t,oage-tsookmg.com:Moab, United btates of America-202 Guest reviews.Book your hotel now! Page 1 of 1 B�IlVG PERMIT APPLICATION ] CITY OF ATLANTIC BEACH �/ 800 Seminole Road, Atlantic Beach, FL 32233 Off-ice(404) 247-5826 Fax (904) 247-5845 Job Address: G4/yytiA,v,4 .S 7- Permit Number: Legal Description s{- 39 3 R - S -- Z S c 5 ec 1-� G+-zP����a`rcel# ) 7 6W1 y -Oil o 0,1. floor Area of q.Ft, !Sq.t Valuation of Work S V Proposed Work heated/cooled non-heated/cooled Class of Fork(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s)((circle one): Commercial esidential 'If an existing structure,is a fire sprinikler system installed? (Circle one): es i N/A FIorida Product Approval 4 ?`f i_ t For multiple products use product approv orm Describe in detail the type of work to be performed: P&W-Wv{- Ply r4-1V 44t 'CC /'Z4i4rze-& t� �y4n? M4 tGer/ 5 -rp r Property(honer Information: Name: u.L_ Address: 4177 0 V0,t CCs i►iv�syr,.Gum{ City . 13 StateC.ctZioczkw,- Phone F-Mail or ax Y(Optional) Contractor Information: Company Name: J3 X1'9 It 7e,,1, f4v-/124;-2 Qualifying Agent: J en v�r /2yc,, Add::ess %102 i0 731 S7At �.s 7.i„z fcs� i;r i 7e is-w3 City PTR Ut s��A.;il,17e State c Zip ��z1 s Oft-ice Phone 1 yrs-y 3► Job Site/Contact Number Fax# Z�-99 Qy State Certification/Registration:i: C<<- DS(a 34s Asci+.iteet Name&Phone 4 Engineer's Name&Phone 9 Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address f?pplicatior.is hereby made to obtain a permit to do the work and gllations as indicated1 certifthat no work or installation has cemrnencedprior to the uance of a permitand that all workwalbe performed to meei thndards ofall lawthisntrisdiction. this permit becomes null a�ci void zfrk is rot comnced within six{6)months, or if cononorork issusa period ofsix(6):nonths at arty time after workcomed i urdersrrnd that separate permits must bered for Electrical Work,Plumbing,Signs, Wells,Pools,Furnaces,Boilers,Heaters, Tanks and Sir Conditioners,etc WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CONMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR INIPROVENIENTt`S TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCII�TG, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. 1 hereby eertj;�t� t 1 have read and e d this nlicaiion and Iviaw the same w be true and correct. All provisions of laws and ordinances governing this type of work will�be comp ' z he er sppeci�d herein or not. The granting of a permit does not presume to give author; to violate or cancel the provisions o;`arry other f" ral.s te, cal!craw regulating construction or the perjormanee of eorsn ucticr.. _ "f US P, 0L- n20C - - V -O Signature of Owner Signature of Contractor ..... .►�......_......_l r.:......... .1�.. .. :.-lam-- Print Name ..........C..,�1-�....cv .`........................................- Sworn to avid ssbscri be re the Sw subscribed �f ejkj e aria Day of t�li 11P� ze i3 this Day o� X01 O:a-v Public N � JENNIFER WALKER �. MY COMMISSION t FF 011480 j EXPIRES:April aMted .2 6.10 ANDREA MARIE PACHOLEK afh Bo(KWThiuNotaryPubkUr#d@rw*rs Commission#E 1881007 jr Notary Public.-C http://www.booking.co ab-550-sem ��t$�,1y0{".htri?aid=311088;label=slhp_moab-550-south-main-street... -X174013 - M Comm.Expires Feb 2R 2n+e t Y CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT State of California County of AX aij Ony UIQ o 33 before me, AM idea- a}� �- ate ff(( !! I 1Here I—erf Name and Title of the Officer personally appeared t tY 1. Mau X Name(s)of Signer(s) who proved to me on the basis of atisfactory evidence to be the persoAs) whose namA) Xe subscribed to the within instrument and acknowledged to me that ANDREA MARIE PACHOLEK &*e/t*y executed the same in( )s);er/fir authorized Commission # 1881007 Z capacitAs), and that b i r/t it signature*) on the Z :�� Notary Public -California Z Orange County instrument the person or the entity upon behalf of M Comm.Expires Feb 26,2014+ which the person ),) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my and and official seal. Signature lace Notary Seal Above Signature of Notary Pubic OPTIONAL Though the information below is not required by law, it may prove valuable to persons relying on the document a d could prevent fraudulent removal and reattachment of this form to another document. Description �f Attached Document Title or Type of Document: �� 4 l C Document Date: Number of Pages: Signer(s) Other Than Named Above: Capacity(ies) Claimed byf �I Signer(s) �, r(s) Signer's Name: JZ 4 w C V w Signer's Name: Individual — i ❑ Individual ❑ Corporate Officer—Title(s): ❑Corporate Officer—Title(s): ❑ Partner—-_ Limited E-1 General `_ �'�' '"'0'r!lrl�er—❑ Limited General ❑ Attorney in Fact • ❑Attorney in Fact • El Trustee El Trustee Top of thumb here Top of thumb here ❑ Guardian or Conservator ❑Guardian or Conservator ❑ Other: ❑Other: Signer Is Representing: Signer Is Representing:- 0 2007 epresenting:©2007 National Notary Association•9350 De Soto Ave.,P.O.Box 2402•Chatsworth,CA 91313-2402•www.NationalNotary.org Item#5907 Reorder:Call Toll-Free 1-800-876-6827