2256 N Fairway Villas Ln 2013 roof CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
-5814
INSPECTION PHONE LINE 247
Application Number . . . . . 13-00003665 Date 11/13/13
Property Address . . . . . . 22S6 N FAIRWAY VILLAS LN
Application type description ROOF PERMIT
Property Zoning . . . . . . . PLANNED UNIT DEVELOPMENT
Application valuation . . . . 2900 -----
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Application desc
REROOF
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Owner Contractor
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BEACHES HABITAT FOR HUMANITY BEACHES HABITAT
797 MAYPORT RD 1671 FRANCIS AVENUE FL 32233
ATLANTIC BEACH FL 322334410 ATLANTIC BEACH
(904) 241-1222
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Permit . . . . . . ROOF PERMIT
Additional desc . . . 00
Permit Fee . . . . 6S . 00 Plan Check Fee
Issue Date . . . . Valuation . . . . 2900
Expiration Date . . 5/12/14 -----------------------
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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 65 . 00 65 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 69 . 00 69 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 2256 N. Fairway Villas Ln. Atlantic Beach, Fl. 32233 Permit Number:
Legal Description : 39-22 08-2S-29E FairwaX Villas; Lot 55 Parcel#
P'loor Area ot Sq.Ft. Sq.Ft
Valuation of Work$ 2900 ,Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair X Move Demolition pool/spa window/door
Use of existing/pro osed structure(s)(circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A
Florida Product Approval# attached
For multiple products use product-oproval form
Describe in detail the type of work to be performed: Remove and replace 20 sq. Asp. Shingles
Property Owner Information:
Name: Beaches Habitat for Humanity Address: 797 Mayport Rd.
City Atlantic Beach State FL. Zip 32233 Phone : 904-241-1222
E-Mail or Fax#(Optional): 904-241-43 10
Contractor Information:
Company Name: Beaches Habitat —Qualifying Agent: Robert Peterson
Address: 797 Mayport Rd. City Atlantic Beach State FL. Zip =
Office Phone 904-241-1222 Job Site/Contact Number: 904-334-1202 Fax#904-241-4310
State Certification/Registration#
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Ap 'cat h reb ade bana e d the work and n a a ns as i ndi cat or installation has commenced prior to the
i rnu rfi i st ','�tiod8 ws this jurisdiction. This permit becomes null
t to
n 00 rk P be e 0 ed to in Z t the',an a a' a
0 k is s, aWenod ofsix(6)months at any time after
(6 in nths or, c rist ct n or O�r
.t in s,_
Y"d th 0
P io
is'.. cc 0 ape it an a a
and ,'d, _ok"not commenced 0 - 0
., is c f me cd I understand that separate perniii,m, t be secured 0,E ectr'c' e s, Pools, Furnaces, Boilers, Heaters,
T, k 0- .
'k,and A" fti" rs'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 application and know the same to be true and correct. All provisions of laws and ordinances governing this
work will be complied with whether s eci ed herein or not. The granting of a permit does not presume to give authority to violate or cancel the
I p fi
provisions of any otherfederal,state, or loca aw regulating construction or the pe�formance of construction.
Signature of Owner Signature of Contractor
Print Name Print Name
�11 W_V+ 4.641_4.............C+eX.5.9n.........................................................
..........................................................................................................................
Sworn tQ and subscribe4 before me Sworn to and subscribed before me
this L20-Day of. r,./O I/C444 Ly-c� 2013 this L2,�Day of NOL/trw do ew— 20 t--S
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