388 11TH ST - ROOF „
CITY OF ATLANTIC BEACH
�SJ 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
.,N INSPECTION PHONE LINE 247-5814
\JS�I�r
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-ROOF-2533
Job Type: ROOF PERMIT
Description: ROOF REPAIR
Estimated Value: $2,450.00
Issue Date: 10/27/2015
Expiration Date: 4/24/2016
PROPERTY ADDRESS:
Address: 388 11TH ST
RE Number: 170092-0000
PROPERTY OWNER:
Name: VAN VOORHIS JR, EDWARD JAMES
Address: 388 11TH ST
GENERAL CONTRACTOR INFORMATION:
Name: JOHN GILMORE ROOFING. INC.
Address: 11647 GWYNFORD LN QA JOHN CHARLES GILMORE
Phone_: - -
FEES:
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
BUILDING PERMIT FEE $62.25
Total Payments: $66.25
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 3 S S ( Permit Number:
Legal Description Parcel#
Floor Area of Sq.F't. Sq.Ft
Valuation of Work$ a 450, 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
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes No N/A
Florida Product Approval# 104,-7q
For multiple products use product approval form
Describe in detail the type of work to be performed: Refuti r1 n rtxf- W ire I t IN i S OteStrge d
cw. . appm L S&
Property Owner Information:
Name: Address:
City State Zip Phone
E-Mail or Fax# (Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: ► & a MTh S , 1 Quail ing Agent:30{�.IZ t IrviCYr_
Address: I . O-c,fQ e n G ' v4 tf I q • City GEC iz,9.r?u (t 2 State FL Zip 3 2223
Office Phone*/• $$0- . 0 Job Site/Cont ct Number 55--/s57 Fax# $$O-(0 a
State Certification/Registration# C C p S 7 Ce 7 q
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 certi&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 f 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,Heaters,
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 this application and know the same to be true and correct. All provisions of laws and ordinances governing this
d
type o1 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 law regulating construction or the performance of construction.
Signature of Owner _ , / , ✓ Signature of Contractor i��, _ f
Print Name _/ / ,
,l--Gl�l/� ^� ,,,,... . .�i4 !j�.�rcr��+�/ Print Name \,16 ,(r�1
t+'"
Before me j // Before me
this 2`? Day of Gto%E2 20 /5--
_ this . Day of • i£ !-- ,20 / S�
4 WILLIE C.RICHARDSON
� �c d S1TjA�T�e OWF3! �t
A otary Public NOTARY PUBLIC otary Pub lc
t� -STATE OF FLORIDA
, �FFI3Nii
E3pUrs aN2/201S