1901 W Sevilla Blvd 2013 roof CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
Application Number . . . . . 13-00003195 Date 8/05/13
Property Address . . . . . . 1901 W SEVILLA BLVD
Application type description ROOF PERMIT
Property Zoning . . . . . . . PLANNED UNIT DEVELOPMENT
Application valuation . . . . 15000
------------ ------------------------------
Applica ion desc
reroof
------------- ----------------------------------------
Owner Contractor
------------------------
KOOBA, FER SHORE ROOFING COMPANY
675 ATLANTIC BLVD 914 7TH AVENUE SOUTH
ATLANTIC BEACH FL 322334025 JACKSONVILLE BEACH FL 32250
(904) 241-8842
------------ --------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . Plan Check Fee . 00
Permit Fee 125 . 00 .
Issue D to . . . Valuation 15000
Expiration Date . . 2/01/14
------------ --------
----------
Other Fees STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
Fee summary Charged Paid Credited Due
----------------- ---------- -------- ----------
--
Permit Fee Total 125 . 00 125 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 129 . 00 129 . 00 . 00 . 00
PERMIT 1S APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
09--
CITY
9— -CITY OF ATLANTIC BEACH
ROOFING PERMIT APPLICATION
Job Address:
U eST J L y 0 a
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f f'q"� 'C/�r1e Telephone: .______—
Address: pSN�1 sl
Roof Contractor. U/L C) Fi ti
State License Number. CSC
13,
Contractor's Address:
N i Fa>c Emaik
Telephones / s�
rr Roofing Material
Scope of Work: /2
FL Product Approval#
-6, 3 Valuation of Work
Req&W Inspections: Sheathing/In Progr -DrY in /Final
If .re-roof: Ash Value of Structure:L/ ,$300.M/>$3WPW RO*�f M
Apprees� to dno a fardN structures only)
'1A/ARNtNG TOO ER: YOUR FAI O REGOR OTKE Of COMMENCEMENT MAY RESULT/N YOUR D PAYING
D
TWICE FOR IAfPRO ENTS TO R PERTIG NOTKE OF COMMENCEMENT MUST BE RECORDED
ON THE 108 SITE EFORE THE /RSI" NSPECTI . IF YOU INTEND TO 08TAIN FINANCING, CONSULT WITH YOUR
IV OUR NOTICE OF COMMENCEMENT"'
LENDER OR ANA RNEYB RE �� ---------_ ------ -_- - --
-- ---
-- -/3
_-- -- - ---- ----- Date:
SIGNATURE OF OVWMNR-
ENID V.JOHNSON
AS TO OWNER: 20�. ` := Commission#EE 204217
Swom to and su re me tha_�� l_- o Expires June 15,2016
State of Florida,Co Duval '' Bonded Tteu Troy fain Insurance 8003857019
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%Produced identification
Type of identificationpQr'oduced /
Date: !7 �_( ----- -- ----- -- -
--SIGNATURE-OF CO CTOR:-- - —- -
AS TO CONTRACT R: day of 20
Swom to and su bed before me this_--- --
State of Florida, rriY Duval Notary's Signature:
# .
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of identification
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SHIRLEY L GRAHAM 32233-5445
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Doc#2013202095,OR BK 1649 Page 2282,
Number Pages: 1
Recorded 08r05r2013 ai 08:31 AM,
Ronnie Fussell CLERK CIRCUIT COURT DUVALor
�ryrWosttsae.
COUNTK�ept�
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RECORDING$10.00 P=UdAi
ENID V.JOHNSON
J-4 = Commission#EE 204217
q Expires June 15,2016
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