374 Plaza 2013 Roof CITY OF ATLANTIC BEACH .
j 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00003735 Date 11/22/13
Property Address . . . . . . 374 PLAZA
Application type description ROOF PERMIT
Property Zoning . . . . . . . RES SF DISTRICT
Application valuation . . . . 0
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Application desc
REROOF
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Owner Contractor
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PALMER AMY JUSTIN LARSEN CONSTRUCTION INC
374 PLAZA PO BOX 1942
ATLANTIC BEACH FL 32233 4784 CATTAIL ST
MIDDLEBURG FL 32068
(904) 241-0320
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . . 70 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 4000
Expiration Date . . 5/21/14
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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.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: actw C,522,—,
Permit Number:
Legal Description S—&q — —OParcel #
Floor Area of Sq.Ft. t
Valuation of Work S Proposed Work heated/cooled non- heated/cooled
Class of Work(circle one): New Addition AlterationRe air 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 one . Yes Nom
Florida Product Approval # 8—
For multiple products use product approval form
Describe in detail the type of work to be performed:
Propertv Owner Information:
Name: AM a. Address: a# Pl
City State_Zip ZZaPhone Q — 2
E-Mail or Fax # (Optional)
Contractor Information:
Company Name: Ing A
Address: City State Zip 32068
Office Phone Job Site/ ontact Number 2� —[f'3/( Fax# 47,6
State Certification/Registration #
Architect Name & Phone #
Engineer's Name & Phone# At
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 installations as indicated. I certify that no work or installation has commenced prior to the
issuance of permit and that all work will be performed to meet the standards ofall laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six(6)months, or if consiritction or work is suspended or abandoned for aperiod ofsix(6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical 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.
/herebv 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
ripe of work will be complied with whether specified herein or not. The granting of a permit does not presume to give a hthori violate or cancel the
provisions ofany other federal, state, or local law regulating construction or the performance of construction.
Signature of Owner L. Signature of Contractor
Print Name Piz /"eo--
......................................................................................... Print Name
Sworn subscri forme Sworn t b rib d r
Zi-
till s a this o
,•;ice` '''•. MARIA PIMIENTA
Public-State of Florida ' ar ubtic-State of Fbrida
b l i c My Cdmm.Expires Jan25,2015 a u l t
Commission#EE 59080 ry •.',;��,d;:�'• Commies on I EE 59080 s
��
NOTICE OF COMMENCEMENT Number OPageess::1 3,OR BK 16606 Page'1329,
Recorded 11/2212013 at 11:15 AM,
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
Permit No. COUNTY
Tax Folio No. RECORDING$10.00
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property,and in accordance with Section
713.13 of the Florida Statutes,the following information is provided in this NOTICE OF COMMENCEMENT.
1.Description of property(legal description): - ��Gj— _ �
a)Street(job)Address:
2.General description of improvements: o o �L, Q r
3.Owner Information
a)Name and address: y t-•
b)Name and address of fee splc titlehol t(if other than owner)_ �—
c)Interest in property
4.Contractor Information
a)Name and address: ,.I K10 e -• 3�Q �
b)Telephone No.: `�0 '. _ Fax o.(Opt.) — /--
5.Surety Information
a)Name and address:
b)Amount of Bond:
c)Telephone No.:_— ---— Fax No.(Opt.)—`_-- -- —
6.I,endcr
a)Name and address:
Phone No.
7.Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a)Name and address:
b)Telephone No.:_ Fax No.(Opt.)
S.In addition to himself,owner designates the follo pens n to receive a copy of the Lienor's Notice as provided in Section
713.13(1 xb),Florida Statutes:
a)Name and address:
b)T'clephone No.: ______ _ Nax No.(Opt.)
encement(the exp• atf a Is one year from the date of recording unless a different date
9.Expiration date of Nutiu of Comm
is specirled):
WARNING TO OWNC.R: ANY PAVMENTS MADE BV THF OWNER AFTER TH1: EXPIRATION OF TllE NOTICE OF
COMMENCEMENTARE,CONSIDERED IMPROPER PAYMFNTS UNDFR CHAPTER 713,PART 1,SECTION 713.13,
FLORIDA STATLJ'1•I?S,AND CAN RNSUIX IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
A NOTICE OF COMMENCEMENT MUST Illi.RN.CORDY..1)AND POSTED ON THF..1OIt SITE J1VFORF.'1'llV FIRST
INSPF:(A'ION. Ile YO11 INT END TO OBTAIN FINANCING,CONSUIX YOUR LENDER OR AN ATTORNEY BEFORE
C'OMMN;N('1NC WORK OR REX'OROINC, YOUR NO'fWE Oh COMMENCEMENT.
COUNTY OF DNMf41, 10•
Signature )w+wr or Owoor's Autlwrintxf Otliu r/I)inx Wr/I'urtrwr/Mu+w+�,cr
Print Nanw. �p ,
Thehe Foregoing instrument was acknowledged 1X bre me this day of /Jd1��CI�.20 �J,by 141 [,n
t
rw
as L)wj .i+�" (lyl►c of authority,e.g.officer,trusfet+,
a(loruey in fact)for 1 191 J 72 (!lame of party oil It f w Ill str Intent was culed).
Personally Known OR I'r(xitiml Ide-ntifica`ticm Notary Signatu•c.
'I'ype of Idcnlitictttion I'rt)luced = `{y(® -(:u 49-V�31'Name(print) IT
ft-. 0R
verification port;uant to Section 92.525,Florida Slaltlt('s. Under lx.naltics oflx:rjury, 1 dcOhle'!list I have r(-.ad the foregoingtuxd that
the facts staled in it arc tt tic to the hest of my kno,vIcdpc and belief.
FORMSIwx'-.nLn+i MARIA m
s ,. sign;+tun nt fnrnl 1'c+snn S,i•, nt.(in lir,;// Ill)AIN)%e
.' Notary Public-State of Florida
'My Comm.Expires Jan 26,2015
• Commission#EE 59080