325 19th St - ReRoof Shingles I
, ' ` � CITY OF ATLANTIC BE ACH
i - 80 0 SEMINOLE ROAD
ATLAN BEACH FL 32233
INSPECTION PHONE LINE 2 47 -5814
.0.219'
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814
JOB INFORMATION:
Job ID: 16- ROOF -326
Job Type: ROOF PERMIT
Description: RE -ROOF - SHINGLES
Estimated Value: $28,000.00
Issue Date: 2/9/2016
Expiration Date: 8/7/2016
PROPERTY ADDRESS:
Address: 325 19TH ST
RE Number: 172020 -0906
PROPERTY OWNER:
Name: HERBENICK, NATALIE M
Address: 325 19TH ST
GENERAL CONTRACTOR INFORMATION:
Name: A J WELLS ROOFING
Address: 5432 WELLER PL ARTHUR J WELLS JR
Phone: - -
FEES:
BUILDING PERMIT FEE $190.00
STATE DCA SURCHARGE $2.85
STATE DBPR SURCHARGE $2.85
Total Payments: $195.70
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 1 - Ra o p 3 Z (o
Job Address: 3 .915 ' 1 —1 ' koA11C ikt pi 2 223 ilermit 2 2l? Number:
Legal Description 362-L 1 -as `a9L S mein n& (,� ni �f -Pa Parcel # ' / 7 f - 090 c
,,,Floor Area of Sq.Ft. Sq.Ft
Valuation of Work $ Z g,.Gd < Proposed Work heated /cooled al X$1 non - heated /cooled o2�f0,�
Class of Work (circle one): New Addition Alteration Repair Move Demolition pool/spa window /door
Use of existing /proposed structure(s) (circle one): installed? Commercial Residenti ��
If an existing structure, is a fire sprinkler system lled? (Crete one : No N /A Lr�2 i
Florida Product Approval # FL-/ V 47 Li . L m L D/L ,/74 t o i l ? pl f _ G - J
Describe in detail the type of work to be performed: ,QOM tie c / rep (. c
OrS( hlaL f sh t Q- r
Property Ower :: ,/ .. a
Name: -fl Q `��" °l-I1 l i!' Address: 3 as / ! « 9
Cit + J Q r th 4 ! 'A Statec-zZip 3 2233 Phone al ( I / q -- 7 - 7 7 9
E -Mail or Fax # (Optional)
Contractor Information:
Company e: J /,()4S r1 AS+ Quali ng Agent:
Address: -5 to S 1 Co 1 Gb . City ale State /l Zip 3 221 /
Office Phone S - S 3 00 C o g Job Site/ Contact Number SS 3 v D Ca, 9 Fax # S If 2_,'3
State Certification/Registration # GC-C- / 3 28 S' ? /
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 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 aperiod 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, F urnaces, 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.
1 hereby certify that I have read and examined this plication 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 gran 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.
V Signatiu - e of Own t, t G 'mil t / / / ignature of Conti
Print Name . 41--Abe " &, 164--
Print Name if-a!u..r vv &/r
Sworn twaannd subscribed before me SworAtq subsc ' efore me
this "Day .f j , r ucL L 20 tP this `d 'Day of LbrKQ r , 20 /Lo
Otary Publ , Notary Public State of Florida rr 1 1�nblic State of Florida •
Kimberly Baker Kimberly Baker
j My Commission FF 012533 My Commission FF 012533 Revised 01.26.10
4,,,,,.0. Expires 04/28/2017 % or Expires 04/28.12017