174 Jackson Rd 2014 Roof CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
jilt
Application Number . . . . . 14-00001389 Date 9/09/14
Property Address . . . . . . 174 JACKSON RD
Application type description ROOF PERMIT
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 6500
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Application desc
REROOF
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Owner Contractor
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MILLER, DANERI WILLIAMS BEACHES HABITAT OR HUMANITY
174 JACKSON RD 797 MAYPORT RD
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 241-1222
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Permit ROOF PERMIT
Additional desc
Permit Fee . . . . 8S . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 6500
Expiration Date . . 3/08/15
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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 8S . 00 85 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 89 . 00 89 . 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: 174 Jackson Rd. AB, 32233 Permit Number:
Legal Description 8-4 17-2S-29E, Dormers S/D PT Lot 15 RECD 10044-958 Parcel#
kloor A a of Sq.Ft. Sq.Yt
Valuation of Work$ 6500.00 Proposed Work heated/cooled non-heated/cooled
t.o.f-
Class of Work(circle one): New Addition Alteratio(�Rep;a�;ir Move Demolition pool/spa window/door
Use of existing/proposed structure(s) circle one):. Commercial Residential
If an existing structure,is a fire s"priler system i7ntafled? (Circle one): Yes No N/A
Florida Product Approval#—_ a__f�z C - —
For multiple products use product approval lorm
Describe in detail the type of work to be performed: Remove and replace approx.. 23 sq. 3-tab asphalt shingle with 30
yj Arch shingles
Property Owner Information:
Name: Danetri Miller Address: 174 Jackson Rd.
City Atlantic Beach State FL—Zip 32233 Phone : 904-610-8037
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: Beaches Habitat Qualifying Agent: Robert Peterson
Address: 797 MMMort Rd. City Atlantic Beach State FL Ziro 32233
Office Phone Job Site/Contact Number Fax#
State Certification/Registration#
Architect Name&Phone#
Engineer's Name &Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
4pplication 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 of a permit and that all work will be ped6rmed to meet the standards of all laws regulating construction in this jurisdiction. Thispei7nif becomes null
ter
and void ff work is not commenced within six(6)months, or if construction or work is suspended or abandonedfor a period ofsixfi months at any time af
work is commenced. I understand that separate permits must be securedfor Electricar Work,Plumbing,Siens, Wells,Pools, urnaces, Boilen,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.
Ihere 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
work will be cotnplied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancO the
t)pe.1�1 mance of construction.
provisions of any otherfederal,state,or local law regulating construction or the peTfoi
Signature of Owner Signature of Contractor
Print Name ..............................
..........
Print Name .........All ... ............................................
Sworn.to.and sub *b d before me Sworn to and subsc *bed before me
a" this Day of .201d
this ojLff Da oif
AAj=E M.FREEMM
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IF OEESOW497J
Revised 0 1.26.10
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