178 11th St 2014 Roof CITY OF ATLANTIC BEACH
) 800 SEMINOLE ROAD
!� V ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 14-ROOF-550
Job Type: ROOF PERMIT
Description: reroof
Estimated Value: $7,000.00
Issue Date: 12/4/2014
Expiration Date: 6/2/2015
PROPERTY ADDRESS:
Address: 178 11TH ST
RE Number: 170257-0000
PROPERTY OWNER:
Name: WOODS, JEFFREY C & CAROLYN R,
Address: 303 6TH ST
GENERAL CONTRACTOR INFORMATION:
Name: DAVID MERRITT CONST. CO.(ROOF)
Address: 108 FLORIDA BLVD QA: MELISSA MICHELLE MERRITT
Phone: - -
FEES:
BUILDING PERMIT FEE $85.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $89.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904)247-5826 Fax (904)247-5845
Job Address: !-{e ( I Permit Number:
Legal DescriptionParcel#
Floor Area o q. t. Sq.Ft
Valuation of Work$ q 00' 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 Residential
If an existing structure,is a fire sprinkler sxstem installed? (Circle one): Yes No N/A
Florida Product Approval# L 10 ISM. /
For multiple products use product approval form
Describe in detail the type of work to be performed:_r'e.ICLo
Property Owner
,Owner Information:
Name:—W 0001if'W Address: .303 (Pf�z S'/-eel--
City taLb State FIZip 143,3 Phone
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS: 1( ,fia� e 9rna-tl.CO�"I
Company Name: Vi O( Mf /t UJKS'_(V-t-C - Qualifying Aent: McAt SS C.k4trr,4
Address: 1170 1 r V i rl ied City Ion%r f, et%�valf State I— l Zip ZZ Z
Office Phone (AT l—t ZS'GJ Job Site/Contact Number G1rl b q 7 Fax# Z ZO-3-7I
State Certification/Registration# CLC_ 13 2 Sri I �!
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 zf work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a�perzod of six 6)months at any time after
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 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 of work will be complied with whether sped zed herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of arty other federal,state, or local law regulating construction or the performance of construction.
Signature of Owner Signature of Contractort4ol_
Print Name4::_ O P.s Print Name M65SQ Aer✓i�-
Before e !B63re
this D y 20 ay,of I 20
Nota Flnrida
N b NbTffirpt431 iC ` Commission FF 086990
Shirley L ah y ices 02/1412..018
y Commis n FF 86990 or P
?orµd`� Expves 02114