1775 SELVA MARINA DR - REROOF f' Jr' ,.
J CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
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-494
Job Type: ROOF PERMIT
Description: DETACHED GARAGE ONLY
Estimated Value: $2,400.00
Issue Date: 2/26/2016
Expiration Date: 8/24/2016
PROPERTY ADDRESS:
Address: 1775 SELVA MARINA DR
RE Number: 172018-0100
PROPERTY OWNER:
Name: STALEY JR, HENRY B
Address: 1775 SELVA MARINA DR
GENERAL CONTRACTOR INFORMATION:
Name: CARBON COPY CONST, INC. (ROOF)
Address: 12412 SAN JOSE BLVD APT 301 QA LEONARD ABRAHAM
SCHONFELD
Phone: - -
FEES:
BUILDING PERMIT FEE $62.00
STATE DCA SURCHARGE $2.00
I
STATE DBPR SURCHARGE $2.00
Total Payments: $66.00
PERMrr IS APPROVED ONLY IN ACCORDANCE WITh ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORII).�
IH'II,DING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 1 ' SE L JA G' A( -kni lc Da. . Permit Number:
Lot-5 aL\C 1"
Legal Description 3 o -a c 019 --a-5 --(4 9 E 5ad 3 Parcel# 1 O 18 - 0 lo c7
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ `-t00 Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one):. Commercial Residential
If an existing structure,is a fire sprinkler system installed?(Circle one : Yes No N/A
Florida Product Approval # FL- 10 N D 6-,ti �r-ur ,i 4,v0 jZ: f FL 15`f 41 (A .
For multiple products use product approval form
Describe in detail the type of work to be performed: V.,ED-CO pbT. cAkt,cD
5-5k I HA
Property Owner Information:
Name: 1f::46-Li 61---A L `( Address: 117 S 56 LJ V`-^-4 w't-An)4 .Pit
City jft'"A tLL .(pct_-, f State kb', Phone Co o — c!L 7 1
E-Mail or Fax#(Optional)
Contractor Information: /
Company Name: C./ t i�,,,,.> �yy Cw-)4 i• -(-tic. Qualifying Agent: L tc� N� �CLN 4 I(1
Address: I `tt 4 6 ■d'U 56 LA/b 3- 3:- City State ft.- Zip 3.1,4a3
Office Phone 8 -(3i e)3 Job Site/Contact Number e G d —9[ 66 Fax# Yx90 r d t 6
State Certification/Registration# L C L o ;- '-ti
Architect Name&Phone# A)/
Engineer's Name&Phone# Al/ A-
Fee Simple Title Holder Name and Address (jf/i-
Bonding Company Name and Address A//
Mortgage Lender Name and Address /J/ 4
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. I understand that separate permits must be secured for Electrical lEork, 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 cert that I have read and examined this a 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 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 76. Signature of Contractor ■
Print Name jj,J(Ly 3.D 3.DA 1,6 Print Name L. . , (��/�lZ L J.-
Sworn to and subscribed before me Sworn to and subscribed before me
thi Day of %'s )iW4C.� 20 this Day of �/
���, .. RUDY MIKSON . RUDY MIKSON
•, v,•: `..a.. L�� a,.„i �.�#FF 097268
No .ry Pu: 31 EXPIRES:March 25,2018 N•taryi. 1C
^. i- oEXPIRES:March 2_52.0 @
df 6naea TVs Public Underwriters - , l wed Tku Notary' i,tV° POW
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