329 11TH ST 2015 ROOF CITY OF ATLANTIC BEACH
sJ 800 SEMINOLE ROAD
;r ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-812
Job Type: ROOF PERMIT
Description: shingle repair
Estimated Value: $2,200.00
Issue Date: 4/9/2015
Expiration Date: 10/6/2015
PROPERTY ADDRESS:
Address: 329 11TH ST
RE Number: 170100-0000
PROPERTY OWNER:
Name: HAYES, JARROD
Address: 329 11TH ST
GENERAL CONTRACTOR INFORMATION:
Name: SCHULTZ ROOFING COMPANY INC
Address: 216 N 20TH ST QA DOUGLAS ARTHUR SCHULTZ
Phone: - -
FEES:
BUILDING PERMIT FEE $61.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $65.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 3 ,-), t �- (1-R - ck Permit Number:
Legal Description " aS - C. a b Aflan�c-Nd'' UJ 1112- L'Of(oh Parcel#
Floor ea of U. t. l K/ Sq.Ft
Valuation of Work$ a00 oc� 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 esidenti
If an existing structure,is a fire sprinkler system installed? (Circle one): es No N/A
Florida Product Approval# G A I- T'— loe,- 1'" e FC T:r- 9 3/ ' -7
For multiple products use product approval orm
Describe in detail the type of work to be performed: Y
Property Owner Information:
Name: J cc-(rc)a i4a e5 _ Address: a�I ( a
City
a State Zip 3113 Phone 7 a l k s 8 ? a
E-Mail or Fax#(Optional)
Contractor Information: �� Z
�� y�pp�n � - �t1 G Quali m Agent: u A/QS S�I-'-
Company Name: u +-L 1�� °► g g State PI Zip
Address: ap- + _City �Ax (���
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Office t' qk, -� 3 1 Job Site/Contact Number Fax
ce Phone ' #
State Certification/Registration# C G C O.3 y
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 work void
ommenced.ot commenced within six I understand that separate permits mumonths or st be secution or work is red for Electricual Work, or Plumbing,Sig s,aWells,Pools,period XFurnaces,Boilermonths at ys timeafter
trs,
Tanks and Air Conditioners,eta
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 AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF CONSULT H
YOUR LENDER OR
COMMENCEMENT.
I hereb certify that 1 have read and examined this application and know the same to be true and correct. All provisions oflaws laws and ordinances governing this
type of work will be complied with whether speci led herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction.
QA
Signature of Owner _ Signature of Contractor
Print Name Print Name 70'.j.1.4 5......._ ...112.......................................
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Sworn to and subscribed before m Sworn to and subscribed be orme 20 --jr
this �S this -,F'Da
,.s��.r '•. RICHARD A.THOMAS ;�+r'� RICHARD A.THOMASON
= Commission#FF 116218
Nota Public :-` xpires Apnl Notary u ',� Expires April 24,2018
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