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67 S Forrestal Cir Roof 2014 CITY OF ATLANTIC BEACH � g1 J 800 SEMINOLE ROAD . V) ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . 14-00000959 Date 6/13/14 Property Address . . . . . . 67 FORRESTAL CIR Application type description ROOF PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ------------------------------------------------------ Application desc FL 2533 ------------------------------------------------------- Owner Contractor - ------------------------ ----------------------- WILSON, RANDY EMPIRE ROOFING SALES & SERVICE PO BOX 330833 2806-1 GIBSON RD ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32207 (904) 246-2627 (904) 334-1661 -------------------------------------------------- Permit . . . . . . ROOF PERMIT Additional desc . Permit Fee 55 . 00 Plan Check Fee . 00 Issue Date . . . Valuation 0 Expiration Date . . 12/10/14 ----------------------------- Other Fees . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ----------------------------------------------- Fee summary Charged Paid Credited ----Due--- ----------------- ---------- ---------- --- Permit Fee Total 55 . 00 55 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 59 . 00 59 . 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 8eqc-IN Job Address: b 7 ForrfS4a,l Cr, S /++kkht CEE�v Permit Number: Legal Description Parcel# Floor Area of Sq.Ft. Sq. t Valuation of Work S `R� 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): ommercial esidentia If an existing structure,is a fire sprinkler system installed? (Circle one : es No N/ Florida Product Approval# R '15 3 3 For multiple products use product approval Describe in detail the type of work to be performed: Tectr o f+- -b 66k, Rt-"al(�►goer-I>( an h s I 1&f '1-i►sh Granv"d t-yWxr cup Sl et't- Property Owner Information: e Name: Rance/ �/1�r SON Address: 6 7 1 OrrCc-fo,[ Cr. s City Atwn yr c 8f9c.6, State f( Zip 3.t -33 Phone -5t!16 — ;(62L7 2L7 E-Mail or Fax#(Optional) Contractor Information: CONTRACTOR EMAIL ADDRESS: n Company Name: r Qualifying Agent: Nedro Xh/n eZ Address: X -1 ow R - City J adQ0A/L1d I t State r Zip 7 Office Phone 3611- 1001 Job Site/Contact Number ;,qy-C7�81 Fax# State Certification/Registration# CGe_(3Ado01 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 six(6)months, or if construction or work is suspended or abandoned for a period of siz(6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools,FFurnaees,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 here, certify thatAe , mined this a icatio and know the same to be true and correct. All provisions of laws and ordinances governing this type ,lb will beether speci ie herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any otlocal law reg lating onstruction or the performance of construction. Signature of O Signature of Contractor Print Name �} Print Name �ed re �V v N e Before me Before me this k_Day of IN this Day of ••••••••NMICHELLE K1.115*1111"A Notary Public State of Florida s� ,A, Notary Public-State of Florida •'r M Comm.Ex ires Jun 27 2016 •:My Comm.Expires Jun 27.2016 -w Commission Ar EE 211793 Notary Public = Commission EE 211793 Notary Public ov r�•�.•• Bonded Through National Notary Assn. %� �••'••, Bonded Through National Notary Asan. �� • NOTICE OF COMMENCEMENT (PREPARE IN DUPLI,-ATE) 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: b� ro lYeCr. S MIag)ic- &� , ft 3223I Address of property being improved: 67 F tictiIg I Lr• S' AV(AAA-& Pe,,ck � C'1' 32237 General description of improvements: �roo r Owner .,eaj 011 1 fns /� Address 61 iirre�a l Cr, s. Maktrt gy,,,k , Fl. 3 az33 Owner's interest in site of the improvement Fee Simple Titleholder(if other than owner) Name Address Contractor Y-4v% o fill Address Rd Dol Phone No. 311 11001 Fax No. ,3 ql - 197 Surety(if any) 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 a is one(1)ye rom the date of recording unless a different date is specified): THIS SPACE FOR RECORDER'S USE ONLY O NER Signed:xthisz�dlay DATE Before of In the Doc#2014131 845,OR BK 1 b'O I 1 Page 2194, Coun vaI'S of Florda, sl Ily a peared Number Pages: 1 himself,'herself and aftir th6ftlls tements an ecl% ,pjerein MICHELLE KLIPSTEIN Recorded Obi 13/2014 at'10:49 AM, are true and accurate :P� °Pry,'=y Notary Public-State of Florida Ronnie Fussell CLERK CIRCUIT COURT DUVAL •e My Comm.Expires Jun 27,2016 COUNTY rE W Commission iM EE 211793 RECORDING$10.00 ( 1 °�F `°�• Bonded Through National Notary Assn. VN � � 1 Notary Public at Large,Stat of tyn A Coun My commission expires: - Personally Knawn _ or Produced Identification