367 6TH ST ROOF PERMIT ° , CITY OF ATLANTIC BEACH
1 'J 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
_ v
INSPECTION PHONE LINE 247-5814
4.740.219
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ROOF-1477
Job Type: ROOF PERMIT
Description: RE-ROOF - SHINGLES
Estimated Value: $11,640.00
Issue Date: 6/28/2016
Expiration Date: 12/25/2016
PROPERTY ADDRESS:
Address: 367 6TH ST
RE Number: 169902-0000
PROPERTY OWNER:
Name: BOUCHARD MARK S & SUZETTE A, *
Address: 367 6TH ST
GENERAL CONTRACTOR INFORMATION:
Name: JACK C. WILSON ROOFING CO.
Address: 4522 ST AUGUSTINE RD QA HAROLD KERTIS VOSS
Phone: - -
FEES:
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
BUILDING PERMIT FEE $108.20
Total Payments: $112.20
PERJII"IIS APPROVED ONI.1 IN ACCORDANCI, WI III ALI, ('I7.1' OF :k•LAN7•IC BEACH ORDINANCES AM) 771E FLORIDA
BUILDING CODES.
JUN-28-2016 08:37 JACK WILSON ROOFING 9043967700 P.01/01
IS U ILDIN G PERMIT APPLICATION
CnY OF ATLANTIC BEACH
• 800 Seminole Road,Atlantic Beach, FL 32233
Office(904)247-5826 Fax (904)247-5845 1 G - o o F.. ( 1 7 7
Job Address: 3 Vi c 1'h W• Permit Number:
Legal Description L a\--?V N-.tc S CIS . -=w‘c. { Parcel# 9 ct l}- N - 6060
J Floor Area of Sq.Ft. Sq.1,T
Valuation of Work$ \.\ tQ' 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 structure(s�(circle one): Commercial Cies
If an existing structure, is a fire sprinkler system installed?(Circle one): Yes N) N/A
Florida Product Approval# . -- . , .I - ti to i o •t
For multiple products use pr. •uct approva orm
Describe in detail the type of work to be performed: C (irKKc - K(711 i eS
Property Owner Information:
Name: �b l✓l __l ��1 'S cmAddress: )10 1 (o 41\ .Y1
City \ t ( C. i ). --U'l Stateet_1 Zip -.4--\,3 Phone 9 1 ci - ci- 1 - °� ``l'V
E-Mail or Fax#(Optional)
Contractor Information:
n
Company Name: ,Ntik� C-• VJ AS ix ` (e-L? Qualify Na
A6 Agent: c A6 V 01.E
kddress: ' . .:a- `s . kN-l; , •� ��^�- 1\Ct t City `.A-y-- State \-A zip �-)=)- I
U
)ff ce Phone t-!iA �4Ce -(., Job Site/Contact Number Fax# q04 31�, 1 lcti)
;tate Certification/Registration CCC.c,p+`t '..?
architect Name&Phone# :39(v 1•M;4-((-,
Tingineer's Name&Phone#
lee Simple Title Holder Name and Address
3onding Company Name and Address
vlortgage Lender Name and Address
1pplication is hereby made to obtain a permit to do the work and installations as indicated I certi that no work or installation has commenced prior to the
ssuance 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
:rid 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
vork is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools,Furnaces,Boilers, Heaters,
ranks and Air Conditioners,tic.
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.
hereby 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 governing this
vpe 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
Irovisions ofany other federal,state, or local lav regulating construction or the performance of construction. 6.,/‘..././
lignature of Own- ,- A , / Signature of Contractor
'rint Name } 6 ...., t_ Ul.t`14 c ....... ......_............__.........._.... Print Name 1 .i 9ta . _...._. .b.E,
;woq to and subscribed before • Swo an subscri be - •e
his Day of ,i , 20[� th •,;ora,• A' ':*o'-HER VOS
`_ •b Notary Pu C•+•. Notary Public -State of
y.. GtiRtST01'MER VOSS -� • j'• r
Iotary Public 0.,_P\.e-- 1 ;- �1:
r° . :: Notary Public-State of Florida (4 •, o�� Comms# FF 044 .h,;l�•�`��: Commission #FF 044
'_•: N_+ ; My Comm.Expires Dec 3,2017 1, Bonded Through National Not., AsSl1 ++•�oss :. f�Through National Nota
1:,;:-..„....,"-.-", Commission# FF 044467 • -
A '.F C �` n....A...+Thr,..inti Al,ti,...el Almost Aeen _O