2331 Seminole Rd (vault) 6695
PSR-3844
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
PERMIT INFORMATION ------- LOCATION INFORMATION ---------
' ermit Number : 6695 Address : 2331 SEM
INOLE BEACH ROAD
E, ATLANTIC BEACH . FLORIDA 322133
Permit Type : RE-ROOF - ---------- LEGAL DESCRIPTION ----------
lass of Work: NEW Lot : Block: Section'
r` of
Type: WOOD FRAME Township : RNG: 0
proposed Use : SINGLE FAMILY Subdivision:
we.1 1 ings - I Codet 0
�?'stimated Value: $0 ,00
Improv . Cost * $0 .00
Total Fees : $22 . 50
Amount Paid,* 522 . 50
OF WITH NEW ShIN APPLICATION FEES
OWNER !JFORMATION
F PERMIT 822 - 50
Name, DALE G , GATZ OA] WATER IMPACT FEE 50 .4r
2331 SEMINOLE BEACH R
ATLANTIC BEACH ., FLORIDITz SEWEF !MPA&-,T FEE
7 METER WATER M
014 ,,,7 A 2
RADON "AS-H .R . S . $0 .00
CONTRACTOR INFORMATION RADON GAS - 5%
Name : RES fDENT IAL ROOF INI WATER TAP $0 . 00
;adre,ss-: 2411 QUAIL AVENUE SEWER TAP 90 - 00
HYDRAULIC SHARE S0 ,00
JACKSCNVILLE, FL 32-:,1r.J RE-INSPECT FEE
License! RC 0052726 Type .
SEC* ,H TMPA('T FEE
OTHER
NOTES:
NOTICE -ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING
PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE
BUILDING MATERIAL, RUBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE
CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER
ANICS' LIEN LAW CAN RESULT
"FAILURE TO COMPLY WITH THE MECHVEMENTS. N
I 99
THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPRO
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
ATLANTIC BEACH BUILDING DEPARTMENT
By:
CITY OF ATLANTIC BEACH
PERMIT APPLICATION ROOFING
Owner(s ) : 44L-c G. G;a-rz --- -
Address: a 33 l SEM i'A)OL.0 .BEkCN KD. Phone:
Lot # Block or Unit # Subdivision-
Contractor: le 00F/-AI C-
-2-q,11
02.q'11 Qrd,4i,L 4VEi1U 6-
Address: fµL.,Lfe,J✓%LLE Phone:
State License No. C 0 OS .2 7 ��
Describe work to be done:_
Materials to be used:
� �a- .3
Signature OWNER: Date:G. - - f
Signature CONTRACTOR: `��