79 Forrestal Roof 2015 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: 15-ROOF-128
Job Type: ROOF PERMIT
Description: reroof fl 5680.1
Estimated Value: $5,000.00
Issue Date: 1/16/2015
Expiration Date: 7/15/2015
PROPERTY ADDRESS:
Address: 79 FORRESTAL CIR
RE Number: 171731-0000
PROPERTY OWNER:
Name: WATERS JR, WILEY DIMPSY
Address: 79 S FORRESTAL CIR
GENERAL CONTRACTOR INFORMATION:
Name: ROMANO BROTHERS ROOFING, INC
Address: 1188 N 12TH ST QA DANIEL JOSEPH ROMANO
Phone: - -
FEES:
BUILDING PERMIT FEE $75.00
STATE DCA SURCHARGE $2.00
PLAN CHECK FEES $37.50
STATE DBPR SURCHARGE $2.00
Total Payments: $116.50
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: �I fP- 0; ° re Permit Number: �eJ�►'�`-�`� "`��
Legal Description Parcel#
Floor Area of Sq.Ft. Sq.17
Valuation of Work SSL-IOU. 0(j Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Additioof Alteration Repair 1�ove. Demolition pool/spa window/door
Use of ex <isting/proposed structure(s) (circle one): Commercial residential `
If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
Florida Product Approval# SLQ'6G. (
For multiple products use product approvaori
Describe in detail the type of work to be perform
Propertv Owner Information:
r0 ,
Name: Address: ( r
City Stat Zip C Phone ,
E-Mail or Fax#(Optional)
Contrac r Inform tion:
Company Nae n dS Qua]' ing Agent: h,
Address: )SS City State ) Zip
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
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 commetsced within six(ti)months, or if construction or work is suspended or abandoned for apertod of six 6)months at any time of er
work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells, Pools, urnaces, Boilers, Heaiers,
Tanks and Air Cantlitfoners,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 INTENT) TO OBTAIN FINANCING, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereby 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
hype of work will be complied with whether specified herein or not. The granting of a permit does not presume to ity to violate or cancel the
provisions of any other federal,state, or local law r fgulating construction or the performance of construction.
�4�Signature of Owner Signature of Contractor
Print Name Print Name�41.le .. .... ............1 ....:- ... �
Sworn o and subseo fore me Sworn to and subscribed before me
thi Day of 20 I this Day of 20
Ci4 Public Notary Public
AMBER L HICKS
/• MY coMMISSION#►FF0 91% Revised 01.26.10
EXPIRES July 9,9019
a �+53 Fw►+daNaa servi :sifs