1175 SEminole Rd 2014 roof (2)CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $59.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID:
14 -ROOF -457
Job Type:
ROOF PERMIT
Description:
roof repairs
Estimated Value:
$1,000.00
Issue Date:
11/18/2014
Expiration Date:
5/17/2015
PROPERTY ADDRESS:
Address:
1175 SEMINOLE RD
RE Number:
171890-0000
PROPERTY OWNER:
Name:
NAUMANN LIFE ESTATE, ANNELIESE,
Address:
908 PRINCE PHILLIP DR 908 PRINCE PHILLIP DR
GENERAL CONTRACTOR INFORMATION:
Name:
MACK BROTHER GENERAL CTRS.
Address:
5521 BARKER ST FREDERICK W MACK
Phone• - -
FEES:
BUILDING PERMIT FEE
$55.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $59.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Job Address:
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH r
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
1175 Seminole Rd.
Legal Description
Permit Number:
23-4 16 -2S -29E Selva Marina Unit 1 Lot3 Blk1arcel#
Valuation of Work $ Proposed Work heated/cooled non-heated/cooled
Class of Work (circle one): New Addition Alteration epair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one):Commercial Residents
If an existing structure, is a fire sprinkler system installed? (Circle one): o N /A
Florida Product Approval # �L-114(a 1 1
For multiple products use product approval torm
Describe in detail the type of work to be
Property Owner Information:
Name: 221 Oleander, LLC Address: P.O. Box 11508
City Jacksonville StateFLZip 32239 Phone 904-502-3414
E -Mail or Fax # (Optional)
Contractor Information:
Cor.
Froc, -�-
Mack Brothers Building Contractors, Inc. Frederick W Mack
Company Name: Qualifying Agent:
Address: 1546 Girvin Rd Unit 1 City Jacksonville State FL "Zip 32225
Office Phone 9n4-2.20-2Snn Job Site/ Contact Number 904-237-0868 Fax #904-237-0868
State Certification/Registration # (4= -12 94 9 7 —
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 mall
and void of work is not commenced within sir (6) months, or if construction or �,ork is suspended or abandoned for a_ period of srx (6) months at any time alter
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.
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 hereby certify that I have read and eramined this plication and know the same to be true and correct. All provisions of laws and ordinances governing this
tvpe o work will be co lied with whether sped ted herei or at. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any wherdhal, state. or IgtplAw regulatingkconstruction or the performance of construction.
Signature o wn l/ Signature of Contractor
n
Print Name 1 f S L- _ [�—jj o _ Pont Name f..4. - .!.. .h...._ ..'... / ........_........
Sworn to and subscribed before me
this IVDay of Noy.r- 200
1
Notary Public
yV'�fltaPAMELA HRYNCEWICZ
P°rt MY COMMISSION # FIF09BI64
4,20
EXPIRES; March 4, 2018
Sondod Thru Notary Public Underwriters
Sworq to and subscribed before me
this &Day of .20
Notary Pubte
01.26.10
PAMELA HRYNCE'M
1.
MY COMMISSION # FF 098164
EXPIRES:
'? of
March 4, 2018
Bonded Thru Notary Public Underwrbrs