365 1ST ST ROOF 2013 I I
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CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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Application Number . . . . . 13-00003135 Date 7/24/13
Property Address . . . . . . 365 1ST ST
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 3900
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Application desc
reroof
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Owner Contractor
------------------------ ------------------------
KERBER DOROTHY G TRUST A CROWN ROOFING INC
365 1ST STREET 2159 ST JOHN' S BLUFF RD S
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32246
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 70 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 3900
Expiration Date . . 1/20/14
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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.
r
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904)247-5845
Job Address: 365 1St St. Atlantic Beach, Florida 32233
Legal Description 5-69 16-2S-29E .21 Parcel # 169770-000
Floor Area of Sq.Ft. q. te
Valuation of Work$3900.00 Proposed Work heated/cooled 1423 non-heated/cooled_fs T
Class of Work(circle one): New Addition Alteratio Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): � Commercial
If an existing structure,is a fire sprinkler system installed? (Circle onePeside
s /A
Florida Product Approval#,�Zz:- Z
For multiple products use product approvalorm ff
Des 'be in detail the type of work to be performed: 0-^- 0=e
Property Owner Informat�ion: �S��a
Name: U � AddressCity !—Zi"-&=P
•Zi"-& Phone
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: 42�� J.d� • ' , T/VC. Qualifying Agent:
Address: / n City QAC SOP►v,Y/c State Zip g=12 9,-4
Office Phone 16 / ` 79d Job Site/Contact Number 74b��,�/Fax# OV-490
State Certification/Registration
Architect Name&Phone#
Engineer's Name&Phone# 14VZ14!1:
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and inas 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 this jurisdiction. This permit becomes null
and void if work is not commenced within s (6 months, or if construction or work is suspended or abandoned for a period of six(6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrics!Work,Plumbing,Signs, Wells,Pools,Furnaces,Boilers,Heaters,
Tanks and Air 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 FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereb certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type o7work will be complied with whether sppeci ted herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction.
Signature of Owner iVt / Signature of Contractor
Print Name �oro�lrr Print Name G �-el '...! ?. .... /�J...............................................
_ .... ..r.............................................................
Sworn to and subscribed before me Sworn to and subscribed befor
this Day of _ dD y
20 L3 this a of
LSON
ro E,r-jrerA04/26/2016
't x.(Jdff _ Notary Public•State of'
of Flo
Nota Public n Jr Notary Public %;ori�;a�` Commission EE 8�4y
Sp J
ry � = n EE t 93470 nQ�►/� """
Of F\e �••'t'`��' .
10-30-00 a is
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of Florida County of Duval
To whom it may concern:
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: ✓ -�j `
Address of property being improved: Acs r
aa �
General description of improvements: Reroofing
Owner
Address
Owner's interest in site of the improvement Self
Fee Simple Titleholder(if other than owner) Dj f�
Name �/
Address 71 -�y
Contractor T-T C-AD�
Address 2159 St Johns Bluff Rd Jacksonville,FL 32246
Phone No.904-619-8790 Fax No. 904-646-1125
Surety(if any)N/A
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name N/A
Address
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
Address 2159 St Johns Bluff Rd Jacksonville, FL 32246
Phone No. 904-619-8790 Fax No.904-646-1125
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 Statut s.(Fill in at Owner's option).
Name /Adi?c��
Address
Phone No.
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a (fib o
different date is specified): ` a�
THIS SPACE FOR RECORDER'S USE ONLY O NER
DATE T, V1 ✓`�\
Signed: �l
Before me this d the
un D to o rift s rsonally appeared
Doc#201 31 91 481,OR BK 16465 Page 2109, himself/ rs and affirms that all state me and rati s hereinJe"~
Number Pages: 1 are true and accurate ti ataii'" 'tl-'-%Morida
. ` 'I William N kynr jr
Recorded 07/24/2013 at 01:28 PM, e p My C6"frrissitfli ft 193470
Ronnie Fussell CLERK CIRCUIT COURT DUVAL " 1111ePO4s 04/21/2016
COUNTY
RECORDING$10.00
Notary Public ,State of . County of
My commission expires:
Personally Knawn or
Produced Identification