257 Belvedere St 2014 Roof �
el g 7 v�� CITY OF ATLANTIC BEACR
\ 111
-y J 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00000066 Date 1/21/14
Property Address . . . . . . 257 BELVEDERE ST
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 6500
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Application desc
reroof
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Owner Contractor
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BESS AMBER L MEDITERRANEAN CONSTRUCTION AND
257 BELVEDERE ST ROOFING
ATLANTIC BEACH FL 322334108 2751 MCCORMICK WOODS DR
JACKSONVILLE FL 32225
(904) 885-0057
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Permit . . . . . . ROOF PERMIT
Additional desc . . . 00
Permit Fee . . . . 85 . 00 Plan Check Fee
Issue Date . . . . Valuation . . . . 6500
Expiration Date . . 7/20/14
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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
----------------- ----------
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Permit Fee Total 85 . 00 85 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 89 . 00 89 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
J BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
.Job Address: 1'5Number:
Legal Description Parcel #
v� oor Area of 5q. t. q, t
Valuation of Work$ Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial Res d itial
If an existing structure,is afire sprinkler system installed? (Circle one): es No N/A
Florida Product Approval # h 1 LA S 6.3 (7�
For multiple products use product approval form
Describe in detail the type of work to be performed: 1P\R_yyr;A:
Property Owner Information:
Name: Y" Address: �2� �p _ _Yti'� + _�
City ALP x 0,._yr�c� StateVAZip �Plione
E-Mail or Fax# (Optional)---
Contractor
Optional) __Contractor Information: CONTRACTOR EMAIL ADDRESS: S-k c>_yr'-,jS 6yL(A12 !4 ttic-kcCy V-A.
Company Name:4e1r 7 _ky kvr •o,." MS&Y c' rF►► Qualifying Agent: - AC S_
Address: 2 I I kx.ve ityNC•_ete% nv%_S 1 ? _State_E_L, �ip 3 =2.25'•
Office Phone(:A0 t•, RSCS•��t i� '`� Job Site/Contact Number qOu •meq, .D\:S► Fax#g0'q.19-0.EtA yG
State Certification/Registration# C2.S 1 rml�A C.C•C X-2,2 8g L.
Architect Name&Phone#
Engineer's Name&Phone#
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 certifi,that no work or installation has commenced prior to the
issuance of o permit and that all work will be per ornred to meet the standards of all laws regulating consu•uction in this jurisdiction. This permit becomes null
and void f work is not commenced within six(6months, or if construction or work is suspended or abandoned for a period of six(6)months a1 any tine after
work is commenced. I understand that separate permits must be secur•ed,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.
I hereby 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
t}rpe o1 work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of am•otherfederal,state, or local law regulating construction or the performance of construction.
Signature of Ow Signature of Contractor ro,% 1-4
C7
Print Name .../�I�I..BENZ..f,J...,�y�i�it!.t�/........._......_.............__._.._._..... Print Name
Befor a Befor e
tills } of 2U _ thi of _ 20
14
e- -
_ _ MONICA TRUCCO
c�ta Public Notary Public �lrc
Commonwealth of virginia = , iiOMM SIGNO
�Iit3 r' brua 4,201 jSe[I 1.26.1(1
7320954=+
t •.�" lonc«:d Thru N my Public n m
My Commission Expires Jan 31, 2014