103 W 3rd St (vault) 19
CITY OF ATLANTIC BEACH
=� f 800 SEMINOLE ROAD
r ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
INSPECTION EMAIL REQUEST:
Building-dept@c2qb.us
Application Number . . . . 07-00000442 Date 4/04/07
Property Address . . . . . . 103 W 3RD ST
Application type description ROOF
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 7250
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Application desc
RE-ROOF
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Owner Contractor
-
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BLAKE, LAURIE GARNER ROOFING INC
103 WEST 3RD STREET 11670 MANDARIN RD
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32223
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Permit . . . . . . ROOF PERMIT
Additional desc . .
Permit Fee 66 .25 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 7250
Expiration Date . . 10/01/07
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- -------
Permit Fee Total 66 .25 66 .25 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 66 .25 66 .25 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
RECEIVED
�S_��lr' BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH
B!1i,_DIru(- R. 70nrNC S
r CITY OF ATLANTIC BEACHAPR 4 2007
-�,•�,•,Sty;.
800 Seminole Road, Atlantic Beach FL 32233 i
Office: (904)247-5826 • Fax: (904)247-5845 i
Job Address: 101 3 Sk mk- wtsk- Permit Number:
Legal Description LOa Ito�t 5 S U 4 ht\(t We &w-k %iaLY, k oL
Valuation of Work(Replacement Cost) 11510.(30
■ Class of Work(Circle one): New Addition Alteration Repair Move
• Use of existing/proposed structure(s) (Circle one): Commercialts-lde-nnlbi
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes T lA
■ Is approval of homeowner's association or other private entity required? (Circle one): �e�s No
Describe in detail the type of work to be performed:
Property Owner Information
Name:
Address: Ia
City M't_ Rrai6 State EL Zip,-'N22I3 Phone 311 444 7,
—
Contractor Information:
Name of Company: (70-CAP-Ir eo�rsq� �.��t_ Qualifyin Agent:
Address: 11611 W@.KaaC,,jn, Citz State_t_ Zip
OfficePhone W- SO- 1116C Job Site/Contact Number 0
State Certification/Registration# UL 1'47.7751 Office Fax# 901!- Z-i 74
Architect Name& Phone 4
Engineer's Name&Phone#
Application is hereby made to obtain a permit to do the work and installations as indicated I certify that no work or
installation has commencedprior to the issuance qfa permit and that all work will beerformed 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 construction or work is suspended or abandoned for a period of six (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.
WARDING 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 COMNIENCENVIENT.
rhereb certi{� 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 type gfworkwill be complied with whether specified herein or not. 7'he granting ofa
permit does not presume to give authority to violate or cancel the provisions of any other federal, state, or local law
regulating construction or the performance of construction.
Signature of Property Owner: L 'i - l� Signature of Contractor: ✓ ��
Sworn lg and subsc 'be¢l efore me Swo and sub ib before me
this�Day of ( ARY PUBLIC-STATE OF FLORIDA this Day of
` Christopher Wyskiver
/1 OIJ14Ccmmission#DD649729 `
Notary Public: �•�I -.—MAR. 12,2011 No Public:
27 3ONDED THRU AM"-nC BONDING CO.,INC. ITATF
OF FLORIDA
REVISED 03.05.07 `:Ci;"isa;pher Wyskiver
Ccnlmission#DD649729
Expires: M ,12,2011
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