1968 Francis Ave roof 2014 CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
4� ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 14-00000809 Date 5/16/14
Property Address . . . . . . 1968 FRANCIS AVE
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 5000
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Application desc
reroof
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Owner Contractor
-
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THOMAS, ELSIE LYNN HOUSE DOCTORS CONSTRUCTION INC
1968 FRANCIS AVE 5782 SAWYER AVE
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32208
(904) 405-3817
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Permit . . . . . . ROOF PERMIT
Additional desc .
Permit Fee 75 . 00 Plan Check Fee . 00
Issue Date . . . Valuation 5000
Expiration Date 11/12/14
----------------------------
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 75 . 00 75 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 79 . 00 79 . 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: , lv� T r CL(I G,S rA C. CW , 8A• Permit Number:
Legal Description ( bT Parcel#
6j Floor Area of Sq.Ft. Sq Ft
Valuation of Work$ ����a� . 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 R denti
If an existing structure,is a fire sprinkler system installed? (Circle one): es o N/A
Florida Product Approval# 05�
For multiple prpdbcts use product approval form
Describe in detail the type of work to be performed: c�-
-1j Z p A<-
Property Owner Information: /
Name: I e n'1 C Address: j s•
City State_Zip Phone!,0 !Z k 0
E-Mail or Fax#(Optional)
Contractor Information: _
Company Name:_ �� Poc�cre 6"s�evcL—Qualifying Agent: vw��
Address: 5782. SAwV�t 1 V _ City AG�GSOW VLLI `G State l=L la. Zip 3z.2�ag3
Office Phone Cl o9- 9 9 4 — 32 c 3 Job Site/Contact Number q o4 q 9, —3Zo 3 Fax#
State Certification/Registration# GGG L 3-Z-S. zr(=>
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. T 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 f work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a_period of six 16)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
COMMENCEMENT.
I hereb 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
type ofYwork will be complied with whether speed herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other feder ,state, or local law regulating construction or the performance of construction.
Signature of Owner Signature of Contractor
Print Name (,�n!1 Print Name
S.l.... ......L�........... ...... ...... ......................
Befo� Be f re m
this '�Day a�e� this Da 20
Commision#EE 149864 P ics e 0f
Notary Publi 9 - _ P o MUM F o eo
�`
OFF Bonded Thru Western Surety Company " rr"pif° °IJt4 18 wised 10.24.12
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of County of
To whom it may concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in
accordance with Section 713 of the Florida Statutes,the following information is stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being improved:
10,
Addr s of property be
013ing improved: v`
_ 3
General description of improvements: L —
Owner ,!
Address
Owner's interest in site of the improvement U ��
Fee Simple Titleholder(if other than owner)
Name
Address 11
Contractor 146 5 I—::—
Address
.Address
Phone No.(<D104"-S 1:�(C 4-- Z Z0 3 Fax No.
Surety(if any)
i
Address Amount of bond $
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in
Section 713.06 (2) (b), Florida Statutes. (Fill in at Owner's option).
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expiration date is one (1)year from the date of recording unless a
different date is specified):
OWNER
THIS SPACE FOR RECORDER'S USE ONLY
Signed t DATE
Beforeoethis4day ofin he
Countyas^� �forida,ha rsonally appeared herein by
_ himself/herE(seelf and affirms that all statementsand declarations herein,I� ,1,,�
- are true and accurate �P�,Yi pVB� AideMauuc
Doc#2014108865,OR BK i 6782 Page 2087, ��` ! �* My Commission#EE 149664
Number Pages:1 n P W'I�S:11130115
Recorded 05/16/2014 at 08:25 AM, !,(7/Y'r Q
G 9
Ronnie Fussell CLERK CIRCUIT COURT DUVAL p Rtinde Surety Comps
COUNTYCount of
q%i&
RECORDING$10.00 lNot4aPu-blicat Large,State of Y i
My commission expires: or
Personally Known
Produced Identification
j it