520 W 9TH ST ROOF 2016 CITY OF ATLANTIC BEACH
y 800 SEMINOLE ROAD
r� ATLANTIC BEACH,FL 32233
v INSPECTION PHONE LINE 247-5814
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ROOF-133
Job Type: ROOF PERMIT
Description: RE- ROOF SHINGLES
Estimated Value: $3,700.00
Issue Date: 1/19/2016
Expiration Date: 7/17/2016
PROPERTY ADDRESS:
Address: 520 W 9TH ST
RE Number: 170945-0000
PROPERTY OWNER:
Name: CROCKETT TRUST, JUANITA T
Address: 521 BIRCH CT
GENERAL CONTRACTOR INFORMATION:
Name: QUALITY DISCOUNT ROOFING LLC
Address: 1794 ROGERO RD QA RICHARD BRIGGS
Phone: 904-396-5000
FEES:
BUILDING PERMIT FEE $68.50
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $72.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845 CO ` RooP— 13-3
Job Address: 5210 UJ• q� a4-ICtn+,C&Ctc'h Permit Number:
>.cras�K tea.
Legal Description 1_i-15e-aS UE Floor Area
&,,4) I N 1-241 Parcel#11 Cft-1�-�
oor ea o t. 'q.Ft
Valuation of Work$._,-XXoC Proposed Work heated/cooled c) non-heated/cooled
yFe_-l2ppf=
Class of Work(circle one): New Addition Alteration -RPS(Move Demolition pool/spa window/door
Use of existing/proposcd.structure(s ((circle one): Commercial 7test
If an existing structure,is a fire sprt'nkler system installed?(Circle one): Yes No
Florida Product Approval* JQ$2(e. i
For multiple products use proTuct approval form
Describe to detail the type of work to be performed:P�Dlf. 11 L&-vrx 40 dtedQ 0WICU -
11C05tll -u ta,h f`O P1JCr
sq
Property Owner Information:
Name: Address: t�G� G-�
City rC State&Zip Phone c
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: 1` Qualifying Agent: r'
Address:�uBl City .lacya-zz v:l a State Zip 3520l
Office Phone ire- Job Site/Contact Number Fax#
State Certification/Registration#-OCC►_:!)ag08S-
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Applicatio»is hereby made to oblain a permit to do the work and installations as indicated I certify that no work or installation has commenced prior to the
i(and[hat a!!work wr11 be a ormed to meet the standards of al!laws regulating construction in this jurisdiction. This permit becomes null
is- -ce of a perm P
and void rf work rs not commenced within six(6 months,or if constructive-or work is suspendek pambba�doped faosr a_peo pof f6J p Botleist Aeaflers
work is conemenced. 1 understand that separate permits must be secured for Elecerica�l WW ng,�E W rw
Tanks and Ao Coadtrioaers,etc
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO OUR YOU INTEND
OBTAIN YONTC H
LENDER OR AN OEORE RECORDING YOUR OIOF
COMMENCEMENT.
I hereb-certify that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governir�¢this
lupe).work will be complied with whether speci red herein or not The granting of a permit does not presume to give authority to violate or cancel the
pro
of any otherfederal,.stat r local law regulating nstruction or the performance of construction.
Signature of Owner Signature of Contractor
Print Name d J,� C�� Print Name 1?_ � ze i al es-
Sworn to and subs 'bed be re a Swo o and su c ' ed efore e
this I tt ay of 20) this I Da o r 20 i
Notary Pu c No c
Revised 01.26.10
JENNIFFER LYNNE CLARK JF,;,,...
} g * MY COh^MISSION#FF 072755
r EXPIRES:November 24,2017
j_7
BcdedThruBudget NotaryServizs gr. ;;ay ccs
JENNIFFER LYNNE CLARK
* MY COMMISSION#FF 072755
* EXPIRES:November 24,2017
srgr`o �P Bonded Thru Budget Notary Services
Doc # 2016011469, OR BK 17430 Page 1658, Number Pages: 1, Recorded
01/15/2016 at 01 :54 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
NOTICE OF CO 1g.?v NC.E;;,sMEW
,PREPARE IN UL)PUC.AJE)
Permit No. _ Tax folio No.
State of = i-x�';'L'i: .— -- _— 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 753 of the Florida Statutes,the following information Is stated in this NOTICE OF
COMMENCEMENT.
Legal description of property being unproved: � �..<�..`~� �� e._ : �•_� —
3P_?r::Ztr.�� �..:�. '� �� 2.��•':.rte= .ate�'?:af ids r + ,s`€.t r�iK.-.•t���" � .�:,�•3
Address of property be!ng irn rov d'c �
General description of Improvements: �_'- -•> "~
CJ`Nni;r .L z3 fZ ` �..�L• •� J
Address !>s + 1 ;'. peui-
Owner's Interest in site of the Improvement
i
Fee Simple Titleholder(if other than owner) —
Name -
Address ------- `
Co^t actor QUALITY DISCOUNT ROOFING LLC.
Address 3481 ST.AUGUSTINE RD.JACKSONVILLE,FL 32207
,
Phone No. Fax No.R66-329-6652
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.
Naive Li
Address -
Phone No. Fax No. —_--
Name of person within the State of.Florida.other than himself,designated by owner upon vvhcm notices or other
documents may be served:
Name -----
Address ---
Phone No. —.Fax No. _
in addition to hirnseif,awner designates the following person to receive a Copy of the Llenor's Notice as provided In
i
Section 713.06(2)(b),Florida Statutes•(Fill in at Owner's option). I
Name
Address ---- -- 1
Phone No. Fax No. 1
Expiration date of Noi ca of Commencement(the expiration date is one(1)year fram the data of recording unless a
different date is specified):
. r
v axd �
THIS SPACE FOR RECORDEMS USE ONLY F oYt R a„ :
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.€..tea::t% r;:i i�'ia._i{__a' herein 5'+ rs
hStnseiffherself and amrms that aii siatemenis and 41S'Wations herein
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