1067 Hibicus St - Re-Roof r '"` v CITY OF ATLANTIC BEACH
s f 800 SEMINOLE ROAD
J =" 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: 16- ROOF -19
Job Type: ROOF PERMIT
Description: RE ROOF
Estimated Value: $3,500.00
Issue Date: 1/6/2016
Expiration Date: 7/4/2016
PROPERTY ADDRESS:
Address: 1067 HIBISCUS ST
RE Number: 171088 -0106
PROPERTY OWNER:
Name: WALKER, MARIE R
Address: 1067 HIBISCUS ST
GENERAL CONTRACTOR INFORMATION:
Name: A CROWN ROOFING INC
Address: 2159 S ST JOHN'S BLUFF RD ROHN, WILLIAM R JR
Phone: - -
FEES:
BUILDING PERMIT FEE $67.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $71.50
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
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247 -5826 Fax (904) 247 -5845 `6 _ R F - 1 9
Job Address: /06 )4, D1 SLUs S'1" Permit Number:
Legal Description t l'Z - 3 3‘ - .2S - a1 E [aec c.,h ,r 6 f Parcel #
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ 3 Coe' .0 0 Proposed Work heated/cooled )) 1. y 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 ' esidentia
If an existing structure, is a fire sprinkler system installed? (Circle one): - • s 125 N /A
Florida Product Approval # FL. "700 ¢
For multiple products use product approval form
/
Describe in detail the type of work to be performed: 1 1 S A/
A.F Ce ,51/4 c il.le�/.�G.
Property Owner Information: ll
Name: A \ c ' e U - . . ) Q Ad dress: / O(y) r 6; S C L. (.---1- City �}�- 1�,-4--t',c_ Qrzy -c-IN State f I Zip 3.) -4 Phone '1 €-/ /o / G zt4..1
E -Mail or Fax # (Optional)
Contractor Information: 11 •(�
Company Name: f LC'Owr.S �E .2jx , v}< Qualifying Agent:
Address:(, 0'/ 13 c..x.11 9:.1%).1 ,) i v CityJc c .nu \L� State V) Zip ?
Office Phonrld q 6./9- $ SD Job Site/ Contact Number Fax #
State Certification/Registration # (''G Z7
Architect Name & Phone # A
Engineer's Name & Phone # .1/�jC.
Fee Simple Title Holder Name and Address /t/4,4-
Bonding Company Name and Address .0 /
Mortgage Lender Name and Address ,/-
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 1 understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Bo 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 1 have read and examined this epplication 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 law regulating construction or the performance of construction. A.
Signature of Owner G /_, . ' • , ,b -/ Signature of Contractor
Print Name ' { r9ti t E X , n l /9 Print Name ii,A in A°:„ 1., t 4 ,
Sworn to and subsc 'bed before me Sw Aug"' I . :. ubsc ibed b - fore me
1 CO
this Day of 40)(4 1v - this I " 1. f Q - , 20
I .y MOHAMMED SHAHID I � � 1
O K, Moiety Public State of Florida Q a r Public ' Commission FF 915709 - Notary Pubh . . � �
My Comm. Expires Sep 7, 2019 ( ;.; be, : r_ MY •M ►NAFF924951
/ /� 4 Bonded through National Notary Assn. `' •`•. eond� . ?ti ' •56�k=
LV T GVI- 3GV VV, Vll 1Jl\ 1 IZ1V Gayc Vim, 1,..11WC1 Gay C 1, 1\C 1L G(J GVIJ
at 11:41 AM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00
NOTICE OF COMMENCEMENT
State of 'f ' Dt`'tr(
Tax Folio No.
County of " t,wc,\ 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 COMMEN MENT.
Legal Description of property being improved: 5 - ,.3 - .2S - e c c. V _ c o r
Address of property being improved: /� 7 )'. 6; SG t,� N ` 4-). � , 4 - ) 3 3 3 _
General description of improvements:]
Owner: Mcx, f j JAI ,F ( _ Address:/) H.. i-,, SG ti ) a
Owner's interest in site of the improvement: �y�
Fee Simple Titleholder (if other than owner):
Name: / -�
Contractor: / I t�Cr t a„., r: LL C_
Address: 15 Oy Sev.e, ' oi .__! z c . n; . 4 - C _ _ -
Telephone No.40y 40) -'S 7 54 1 Fax No:
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)(6), 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 (I) year from the date of recording unless a different date is
specified):
-
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Signed: /c L A ! / Date:
Before me this Al day of • • in the County of Duval. State
Of Florida, has tie . ' appeared
Notary Public at Large, State of Florida. County of Duval.
My commission expires: 1 �� /9 g - - - - - 4. ..
Personally. Know: ' t ,.•o, r.,, MOHAMMED SHAH([
Produced Identification: y� �a Notary State of Florida
, ' •, i • Commission ,9 FF 915709
/) %?+ C My Comm. Expires Sep 7. 2019
1 ''�0.t &tidedthroutti National
/ �/ / Notary Assn.