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331 SKATE RD - ROOF j rL`� .._ \�s CITY OF ATLANTIC BEACH f 800 SEMINOLE ROAD J /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-2916 Job Type: ROOF PERMIT Description: RE ROOF Estimated Value: $4,300.00 Issue Date: 12/17/2015 Expiration Date: 6/14/2016 PROPERTY ADDRESS: Address: 331 SKATE RD RE Number: 171677-0000 PROPERTY OWNER: Name: REVERSE MORTGAGE SOLUTIONS.INC Address: 2727 SPRING CREEK DR GENERAL CONTRACTOR INFORMATION: Name: A-Z ROOFING, INC. (GC) Address: 1032 W EDGEWOOD AVE QA ETHELYN ROSEBORO Phone: - - FEES: BUILDING PERMIT FEE $71.50 STATE DCA SURCHARGE $2.00 STATE DBPR SURCHARGE $2.00 Total Payments: $75.50 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 IS —(- ©o _Z91 (47 800 Seminole Road, Atlantic Beach, FL 32233 j7 4' . a Office (904)247-5826 Fax (904)247-5845 .lob Address: 33) j Kw re 9\a, Permit Number: Legal Description 31-d t 3 - LS Z4C Parcel # Floor Area of Sq.Ft. Sq.l.t Valuation of Work S tit-3 0 0 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 structures)(circle one): Commercial 'eside i If an existing structure, is a fire sprinkler sy m installed?(Circle one): •e No N/A Florida Product Approval # i-L�q S For multiple products use prod approval o Describe in detail the type of work to be performed: 'k e --(k o o Property Owner Information: Name: Sn{ _Je e kokAlf, , \:w.'.lelAddress: 101-0 Vole U City . • State rAZip`tl 6 0c Phone E-Mail or Fax#(Optional) Contractor Information:] /Company .me• !-�- V 117) ! Qualifyin: Agent: Address. 'c.,/ 110KIES :' ',f City J. State � Zip y 22/c` Office Phone /7 . - i Job Site/Con act Number O j/ `�i,l, Fax# (q i•�j7 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 Application is hereby made to obtain a permit to do the work and installations as indicated. I certi.b,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 sus ended 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 ElectricalpWork, 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 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 s mired herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other federal,st , aw re,�ulal' struction or the performance of construction. Signature of Owner Signature of Contractor ;4*9/42160 Print Name Qu�t(4- Print Name T/1c 5 -1= YJ Sworn, o and subscribe. fore m l' Swo t and s bsc ' d before me this i, Day of Wore pet\j,/ , 20 1) this _ . Da G� A e _ • ,. TONI GINDLESPERGER I �. .1101 I::•. '.� /u1 „ ., SSION 1 FF924951 Notary Pus JEMNIFER CUSUMANO o ary Pub lc I �;. • ••: I r MY COMMISSION k FF899201 .. . , .. 1 EXPIRES July 13,2019 140 71 ill14153 ilord.NOts Unice.carr NOTICE OF COMMENCEMENT (PREPARE IN DUPLICATE) Permit No. J Tax Folio No. State of j/y�/ County of 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 COMMENCEMENT. 11 Legal description of property being improved:3I-at+; 3 ZS 2"1E R/? of R0 YCL 0.4m to t-of c.6 Z,-k o/r< 43tc. 4<si t G S Is- Address of property being improved:331 S�(,q %� �w f'L Q�a 1-L 322_33 General description of improvements: t ilia Owner Jt v\ vv1.. vV\041-6.10-3 e °kikvvi 5 I. w.■1e A Address l\ '4 i.0 VC... e Q-■\U V— 41/4) \r1Ay Lt-)Un CA 4°C- , Owner's interest in site of the improvement Fee Simple Titleholder(if other than owner) Name Address Contractor • tO I� ►� tlTXf/ �v P, y Address � II�R�l�Y.11IL:�IMO/ir 4► Phone No. W/7/— / Fax No. Surety(if any) Address Amount of bond$ Phone 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 Phone 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 Statutes.(Fill in at Owner's option). Name Address Phone 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 1 Signed: �� DATE I I I I �S Before me this 11, day of Y 19[ in the Doc#2015286664,OR BK 17401 Page 1033, County a'D Fl ida—h s p uo'na:isy!appeared Number Pages:1 — herein by himself; erse:f and affirms that all ..-, and declarations herein Recorded 12/17/2015 at 10:29 AM, are true and-f}cc ate Ronnie Fussell CLERK CIRCUIT COURT DUVAL :; ` .IEN1 � CUS(jyA>�Q COUNTY RECORDING$10.00 �'COR/A11SStNON#FF8p9201 EXPIRES Juy 13,2019 ota y Public at Large.St,a of ""'"�'r'-``"+"!