95 W 13th St 2014 Roof �s CITY OF ATLANTIC BEACH
ij 800 SEMINOLE ROAD
s) ATLANTIC BEACH,FL 32233
J -r
v INSPECTION PHONE LINE 247-5814
14-00000453 Date 3/25/14
Application Number 95 W 13TH ST
Property Address . .
Application type description ROOF PERMIT
Property Zoning
TO BE UPDATED
7250
Application valuation . . . -------
-----------------------
Application desc
reroof ----------
Contractor
Owner ------------------------
------------------------
HILL, ROBIN C GREAT WHITE CONSTRUCTION IN
95 W 13TH ST 4320 DEERWOOD LAKE PWY
ATLANTIC BEACH FL 32233
JACKSONVILLE FL 32216
(904) 838-1659
----- --------
Permit
. ROOF PERMIT
Additional desc plan Check Fee . 00
Permit Fee 90 . 00 7250
Valuation
Issue Date 9/21/14 _
Expiration Date -------
_____ -------------- 2 . 00
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00
STATE DBPR SURCHARGE -----
_____ ------------------------------Credited--- Credited
Paid Due
Fee summary Charged _ _ _---------
g 00
------Tota- 90 . 00 90 . 00 . 00
. 00
Permit Fee Total 00 00 . 00
Plan Check Total 4 . 00 . 00 . 00
Other Fee Total 4 . 00 94 . 00 94 . 00 00 . 00
Grand Total
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Doc # 2014065251, OR BK 16728 Page 1179, Number Pages: 1 , Recorded
03/25/2014 at 01 :55 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10 .00
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PJtC A t R .0 FLSEIP`E l i
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BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: q S w S 19±1 cAn fiL $Pr�r� �' 3��7' Permit Number:
#
Legal Description Qhs N Parcel
r 10or o Sq.Pt
1=' Proposed Work heated/cooled non-heated/cooled
Valuation of Work$ 1 �•SU• d/
p
Class of Work(circle one): New Addition Alteration Repai 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 o N /A
Florida Product Approval# I d( c) (I
For multiple products use product approval orm 5
I �
Describe in detail the type of work to be performed: I" 0 c `SGI
Property Owner Information:
Name:
j Address:
Phoneq aTk_l
City State Zip U a'
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Qualifying Agent: S Zi ��,-?r�to
Ply Wl D City J rkX State F t- P
Address:�3 0 4 Fax# 1-9[p o- -70-10-114 6
Office Phone °j'Q y- ����/�f Job Site/Contact Number 13�-II(oSGI �—
State Certification/Registration# 1 U`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
that no work or
commence
Application is hereby d that all work will bethe
1performed toomeet the standards of all lark and installations as lws regulatincated I g construction in thiinstallation
jurrisdicttion.his permit becomesrior onull
issuance of a permit an or
and void if wornot understand that separate permits must be secured for Electrical Worki Plumbing,Sigor abandoned ns,or aWells�Poolsxl�urnacesmonthsBoileat ys,Healers,
work is commenced
Tanks and Air Conditioners,etc.
OWNER: YOU YOUR PAYING TW 4 LURE To EF
A NOTICE OF
WARNING TO IMPROVEMENTS
PROVEMENTS
COMMENCEMENT MAY RESULT IN CONSULT
TO YOUR PROPERTY. IF YOU INTEND TO E RECORDING YOTAIN UH
R NOTICE OF
YOUR LENDER OR AN ATTORNEYCOMBE FORE
ENT.
1 here b certify that 1 have read wand ith whethned t eciaedlhertein or not, Theeg tinting of same to be to perue amit doesnd cnot. �pYll esumelto gons o elaauthty to ws and l violatences gor cancel this
type . .work will be comp p
provisions of any other federal,state, or local law regulating construction or the performance of construction.
Signature of Owner
C ,�j� Signature of Contractor 4
�c:N►��� -T-a.
_
PrintName l 5 ....................................................
I,, Pit/
...........r.. ..... ....... a.u .H.. .. .
PrintName . IUl..t1.........t1.1.. .'.............................................................................
Swo to and subscribed befor Sworn to and subscribed before e
RIDGEWAY this Day of r
this Day of (�Y "Y P ate of Florida
a .`�i Notar, YUI)IIC �P`�w r ASHLEY RIDGEWAY
=' * MY Cu.°.m•Expires Jun 20,2017
s* « 66 Otary Pub �om,,
2017
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