178 BEACH AVE 2015 ROOF CITY OF ATLANTIC BEACH
s f 800 SEMINOLE ROAD
r ATLANTIC BEACH,FL 32233
v INSPECTION PHONE LINE 247-5814
a.ri J1319"
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
306 INFORMATION:
Job ID: 15-ROOF-1548
Job Type: ROOF PERMIT
Description: fl 11560.4
Estimated Value: $19,000.00
Issue Date: 7/13/2015
Expiration Date: 1/9/2016 _ -
PROPERTY ADDRESS:
Address: 178 BEACH AVE
RE Number: 170210-0000
PROPERTY OWNER:
Name: 178 BEACH AVE LLC
Address: 6 E BAY ST SUITE 500 _
GENERAL CONTRACTOR INFORMATION:
Name: RON RUSSELL ROOFING INC
Address: 4419 HUDNALL RD QA RONALD WAYNE RUSSELL
Phone: - -
FEES:
BUILDING PERMIT FEE $145.00
STATE DCA SURCHARGE $2.18
STATE DBPR SURCHARGE $2.18
Total Payments: $149.36
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 178 Beach Avenue Atlantic Beach FL 32233
Permit Number:
Legal Description Lot 5, Block 31 Atlantic Beach PB 5 a e 69 Parcel1.
# 17021 0-0000
oor Are o Sq.rt.
Valuation of Work$ �g4Ocb•oy 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 i
If an existing structure,is a fire�uct
"ler system>tn tailed. (Circle one): Yes 1( o N /A
Florida Product Approval#
For multiple products use propproyaorm CC
Me�
Zr�S ��:ha lJ � .k
performed:
Describe in detail the type of work to be
�5O �ac��d o►n ex{-�r���r- ����dn 1-s sec+�✓1
Property Owner Information:
Name: 178 Beach Avenue LLC Address: c/o David Edwards 200 W.Fors h St. Ste 1300
City Jacksonville State FL Zip 32202 Phone 904-699-5333
E-Mail or Fax#(Optional) dedwards edcolaw.com
Contractor Information:
Company Name: u 5,d �z -r- • Qualitng Agent: krf' L Zi 3Z20Z
_State, _ P
Address: Fax# (909)63(fl9509
—
Office Phone O l — 07 Job Site/Contact Number(q04)7114-l 907
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
t no work or installation has commenced
the
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App{icatioonas elermeb a d hat al obtain
will belperformed toomeet the standards of all ark and installations as lws regulatincated. I g onstruction In this jurisdiction. Thispermit bectime a
omesrior ofter
issuance f por work is su or
and work pen
void
i mrk is not commenced within six I understand that separate permits must or abando
be secured for Electrical, rkd Plumb ng,Signs,ned or aWells, Pools, ur acemons,Boilerhs at s,Heaters,
Tanks and Air Conditioners,etc.
A NOTICE OF
WARNING TO OWNER: YOUR FOAUIRL P PING TO TWICE FOR IMPROVEMENTS
COMMENCEMENT MAY RESULT
TO YOUR PROPERTY. IF YOU INTEND EFOBTAIN
RE RECORDING YOUR NOTICE OF WITH
YOUR LENDER OR AN ATTORNEY MMENCEMENT.
a ,
and
the same to be true and
t. All
ons
nces
I hereb ce hfy jl be complied with whetherteci zedlzcati(hereint or not.oxThe granting of a permit doescnot presumetogive authority tolaws and lnaviolate gor cancel tthe
type of wo p p regulating construction or the performance of construction.
provisions of any other federal,state,or 10c21 I
ISG iLI.L. .
Signature of Owner Signature of Contractor
Print Name � C .....................................
Print Name
..................... .
........0.........
Sworn to and subscribed before me 20
Sworn to and subscribed pefore me 20 5 this 2(o'N'Day of Ty nQi
this lc{- Day of M �Fu'bliic
TERRANCE SANTILIf
i rySTATE OF FLORIDA
Notary Public t, My COMMISSION t FF 118589 Nota ��91 6455
EXPIRES:November 20,2018 ExPt{es 51 12017
VN& 0 Bonded Thru Notary Pubk Underwriters