368 4th St 2014 Roof , CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
+} ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00000226 Date 2/18/14
Property Address . . . . . . 368 4TH ST
Application type description ROOF PERMIT
Property Zoning . . . . . . . RES SF DISTRICT
Application valuation . . . . 2200
----------------------------------------------------------------------------
Application desc
REROOF FL10674 . 1
----------------------------------------------------------------------------
Owner Contractor
-
------------------------
-----------------------
FOX LAURA A ET AL ROMANO BROTHERS ROOFING, INC
352 7TH ST 601 OLEANDER COURT
BRIGOCKAS LAURA H JTROS NEPTUNE BEACH FL 32266
ATLANTIC BEACH FL 322335434 (904) 246-5649
----------------------------------------------------------------------
Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee . . . 65 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 2200
Expiration Date . . 8/17/14
--------------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
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.
IF BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 7-?L/ 5 77 Permit Number:
Legal Description Parcel#
Floor Area of Sq.Ft. Sq*
t
Valuation of Work$ 2, 2 OOc u' Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Additions Altera ' Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercialeside
If an existing structure,is a fire sprinkler system installed? (Circle one): es No /A
Florida Product Approval # /c?la 74,
For multiple products use product approvalform
Describe in detail the type of work to be performed: ,cl lv - �z�d`� r, k4(4 e� 46/
Property Owner Information: 09kiLl I
Name: {^4 �� Address: le g
City 7' State,Zip Phone `7 Dom— SL !!;-o
E-Mail or Fax# (Optional)
Contractor Information:
Company Name: Qualifying Agent: 4,L14 /22 e%dZi
Address: City ,4-r kms,R,,t,r State Zip 3
Office Phonegb •S Job Site/Contact Number JZ,a,- pq"ax#
State Certification/Registration# CC (31$$9 3
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 certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within siz(6)months, or if construction or work is suspended or abandoned for a period of szx16)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells,Pools, urnaces,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
C N EMENT.
I hereb certify that 1 have read and examined this application a to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether specified herein o g of a permit does not presume to gry authority to violate or cancel the
provisions of any other federal,state, or loco law regulating co erformance of construction.
Signature of Owner # Signature of Contractor
Print Name �4t.(ti✓-G�,r Print Name .�
�" Before me
thiBefore Before rid Da of 2 this Day of 20
" :
N
Notw Pu 3 Notary Public
"' Revised 10.24.12