509 CAMELIA ST - ROOF CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
+� "r 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-1764
Job Type: ROOF PERMIT
Description: RE-ROOF FL 7006-R4
Estimated Value: $6,480.00
Issue Date: 7/23/2015
Exxpiration Date: 1/19/2016
PROPERTY ADDRESS:
Address: 509 CAMELIA ST
RE Number: 170899-0800
PROPERTY OWNER:
Name: MCKENZIE. DARRELL J
Address: 509 CAMELIA ST
GENERAL CONTRACTOR INFORMATION:
Name: CBI CONSTRUCTION, INC.
Address: 5472 FIRST COAST HWY SUITE 6 QA WILSON DALE COLE
Phone: - -
FEES:
BUILDING PERMIT FEE $82.40
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $86.40
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 571)9 ( ,vi / c e Permit Number: I S-R00p- L7e4
Legal Description t5S 1 7 - 2 5 - Z °( L ,9 rtvionc rarceuf
w Floor Area of Sq.>~t. Sq.Ft
Valuation of Work$ (9 (4 -' Proposed Work heated/cooled //q11 non-heated/cooled //W
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 s rinlcler system installed?(Circle one . s o the
Florida Product Approval # FL-70 U L R 4-1
For multiple products use product approval form
Describe in detail the type of work to be performed: E �t.O V i N (¢ >1=X 1ST 1(6 C- Roo F�
EL 3 S Si-Z-(1/1
Property Owner Information:
Name: r Pl4 a Assc!-s , LLG BOO iJ Ntgocc £c, .c, s .• r .2cc) Address:.
City AK s f,:, State 1Zip 7'?S1 Phone 5l - $'S/- gc5-c)
E-Mail or Fax#(Optional) 5, g,.f- g MS Re.u.,.41 Gwn
Contractor Information:
Company Name: C-151 CoAl JN Qualifying Agent:
Address: 51-17-2- Fte-}T C."4 011 STC (, City FEc,, t�At�R (mkt State PL- Zip 31o34
Office Phone`1a4) 3 o2-1(oO b Job Site/Contact Number(�[)L) 2S 1-S 4 rtO Fax#(`joy) - 35 bU
State Certification/Registration# LLC_ t 3.Z 7-cl 7-9
Architect Name&Phone# ti A
Engineer's Name& Phone# 'V Pr
Fee Simple Title Holder Name and Address ck) 4
Bonding Company Name and Address N A
Mortgage Lender Name and Address N ✓�-
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 commenced within six(6)months, or if construction or work is suspended or abandoned for a period 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, Healers,
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 hereby certify that i have read and examined thisplication 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 specified 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 lw regulating construction or the performance of construction.
Signature of Owner ( ,� "�•� J
Print Name ll h i I l i? z S..............................................
Swo to and subscribed before me
this f'Day of 311 . 20 `5 ,,.,..
CzrA2)-,)
„o ALISA MARIE COOPER
MY COMMISSION#FF088730
Notary Public s°' EXPIRES February 2.2018
(407)398.0153 FIondaNOtaryService.com
Signature of Contractor 11/;66-.- ALL. &-4
4'
Print Name MVO”) ,a& /e_
Sworn to nd subscribed before me
this .? �b ay of du ,20 IS_ •t• • MELANIE ROSE MOORE
. 1 NOTARY PUBLIC
i _ mmSTATE OF FLORIDA
Notary Pu∎ '- 0" Co *FF066467
•Revised 01.26.10
Expires 3/21/2018