1964 Sevilla 2015 Roof \JS r 'Jlr
11 SS CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
' E ji19r
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-907
Job Type: ROOF PERMIT
Description: reroof fl 10184.1
Estimated Value: $16,500.00
Issue Date: 4/20/2015
Expiration Date: 10/17/2015
PROPERTY ADDRESS:
Address: 1964 W SEVILLA BLVD
RE Number: 169462-0415
PROPERTY OWNER:
Name: BROCKWELL, PAUL HEATH
Address: 1964 W SEVILLA BLVD
GENERAL CONTRACTOR INFORMATION:
Name: ROOF IT RIGHT LLC
Address: 2175 KINGSLEY AVE SUITE 207 QA BRIAN J. CAMERON
Phone: - -
FEES:
BUILDING PERMIT FEE $132.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $136.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
NOTICE OF COMMENCEMENT
State of Tax Folio No.
TT
County of Jamu vat
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of
the Florida Statutes,the following information is stated in this NOTICE OF CO
l/yNCEMENT.
Legal Description of property being improved: lg, 71- �� �tv cele -(1
Address of property being improved: / �l/�� �/e�V 'l K `'� `��' 6'v e- kn- �` L 3 d w
General description of improvements: K 7"
Owner: f7- At Address: S ty I l't �- cj�z
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
ontractor:
Address:
Telephone No.: Fax No: _ 6
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of Florida,other than himself, designated by owner upon whom notices or other documents may be
served: Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement (the expiration date is one (1)year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Signed: Date:
Before me this day of_ 4e�Co7. S value a�
Of Florida,has perso ally appeared i
Notary Public at Large,State of Florida,County of Duval
My commission expires: �) w•, (_ r��
Personally Known: or
Produced Identification G r►t �i'Q
Qv Y�v T.HITE
Doc#2015088414,OR BK 17136 Page 2329, 5 ' , MY COMMISSION U FF 186420
_; '�- EXPIRES:January 18,2019
Number Pages:1 1
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office(904) 247-5826 Fax(904)247-5845
Job Address: f v;1A, Permit Number:
Legal Description o .3�' Parcel #47 Yea ° s
Floor Area of Sq.Ft. Sq'
t
Valuation of Work$ 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 strugture(s)(circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No /A
Florida Product Approval# fZ 161,Iy, / 1•'r l./l.,. l�l�
For multiple products use product approvalformform ,Q
Describe in detail the type of work to be performed:
Property Owner Information: C( ��
Name: rt� J.5 V �µ h r * Su-n"L`Address: I `! y k ; h A/.J kir S�
City u a State f Zip dJ3 Phone V C-- 5k-)S--
E-Mail
illSE-Mail or Fax#(Optional)
Contractor Information:
Company Name: )� Qualifying Agent: 8,0-;a µ ti.uzro�
Address: r City Or State- j Zip 3a6T�
Office Phone !7,0 y- 6-11 11.it Job Site/Contact umber 90 y-5 y/-/)9/ Fax# 9104/`sy/-I 19�}-
State Certification/Registration# CC 1 3a 9I 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 cert that no work or installation has commenced prior to the
istuace of a penmt and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
id if work is not commenced within six(6)monthsorif cnstructior abandoned for apenod of six(6)months at any time after
s commced. I understand that sepaate permits must be securPlumbing,Signs, Wells, Pools, Furnaces, Boilers, Heaters,
Tand 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 cert that I have read and examined this app,lication 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 specii 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.
Signature of Owner :;� Signature of Contractor
Print Name i Print Name I F 1 0,4 aM �" .
Sworn�to and subscribed b ore me Sworn to and subscribed befor me ��--
this_ Day of 20 / this Day of_, � — 20—
Notary Public o
T. E f;asM' Ri., i gur
WE
COMMISSION M FF 186420 + MY COMMISSION t FF 186420
i EXPIRES:January
;�• �° EXPIRES:January 18,2019 ��;•...•��� 18,2019
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Bonded Thru Notary Pubic Underwr6re