97 W 13TH ST ROOF PERMIT CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
I
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ROOF-1490
Job Type: ROOF PERMIT
Description: RE -ROOF
Estimated Value: $6,000.00
Issue Date: 6/30/2016
Expiration Date: 12/27/2016
PROPERTY ADDRESS:
Address: 97 W 13TH ST
RE Number: 170804-0475
PROPERTY OWNER:
Name: TUCKER, TERI JO
Address: 97 W 13TH ST
GENERAL CONTRACTOR INFORMATION:
Name: GREAT WHITE CONSTRUCTION INC
Address: 4320 DEERWOOD TRAVIS SLAUGHTER
Phone: - - —
FEES:
BUILDING PERMIT FEE $80.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $84.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
' CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office (904) 247-5826 Fax (904)247-5845 L Co-ROOF- _ ( 4010
Job Address: 611 W 15 StPAVJA1e &CLC 1 R, 32-2.3 Permit Number:
Legal Description 1b
AMCAC., t�1 �5 Si*IQ HCl) � Parcel#
& Floor ea o �� Sq.Ft.itt a.t0-23to 8 c, 1 Sq.l~'t
Valuation of Work$ Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration 'epa'- Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial .
if on existing structure,is A.fire s; nller.s stem • faked?(Circle one): - Ado tit/A
Florida Product Approval# .OfG4 (l l g`1 '(z
For multiple products use product approval form
Describe in detail the type of work to be performed: ? kg WI b/u2
Property Owner Information:
Name:-c-'\ W\ Address: 6t1 X13 lti'lli S..\--
City G.W t f-eQL,V1 State'1tiZip &2733 Phone O ( - WV,
E-Mail or Fax#(Optional)
Contractor Information:
Company Name•& A.V .A f 11 _ L kr'll— Qualifying Agent:1Q lS S �" �
Address:445ZO RGtt(v t t t ' $ 3 City J cju k-e State _- Zip 322.
Office Phone k'i•-112S Job She/Contact Number $ • 1LOV1 Fax# ''7 {0•
State Certification/Registration# CCC 13240en
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 abandonedfor a_period of six f6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical-Work,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 certify that/have read and examined thisplication 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 ?bid •V `% •
Signature of Contractor
Print Name _....ler i Kt.l,)--c--, Print Name 1-WC ,Cti(JOXIbt.11->
Swo andsabscri. before a,- Sworn o and subscr::-dbefore me' ,20
this! ay of _ . ; ,_20 th' 1Day of / _ /
(751
0,/,&,,„1
t.I
Notary Public * •
ttAy * MY COMMISSION i EE 224988 otary Pub MY COMMISSION#EE 224888
`'iI�'. EXPIRES:August 28,2016 *:-:_-7.4:).,-,/:,,
"�` * EXPIRES:Angus B,2016
N,'o v„.0‘, Bonded Bended Thru Budges Notary Seven ,r,5�e a cape'. Bolded Dm Budget s,�d 01.26.10
a
Doc # 2016146793, OR BK 17613 Page 2182, Number Pages: 1, Recorded
06/27/2016 at 03:59 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY
RECORDING $10.00
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Tax Folio No.
State of V)t� County of VWLJOJ-
To whom It may concern:
The undersigned hereby informs you that Improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statutes,the following information Is stated In this NOTICE OF
COMMENCEMENT. 1�11__ , ,w�Ao �n ` l PT
Legal description of property being improved: f4**(L4 C-k` 6e.co t sec t'1 WTS S,1J
etc 0 0)9- 'tots l? - Z3U, 9,1* —1
Address of property being improved: 61 ►� 1 Jt" sr
- cu U,t.Y !. l C B&Q)A ft, 3773�J
General description ?JCl_
•of improvements: Q. -
Owner \-PA2A
Address a`l W 13+1'N S; 04-laia4tC ' GIc_AA 57,233
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address ,�7�� {7 �, 1 - ,,
Contractor 1 tine'\ 1�- )Fi(� 4 1�'e�tCJcvct-Von
t
Address SttcC e y2pl 3 Lb`i1rF s tC tow �ttf �LF\r l J tL 3Z2 l
Phone No. (p41•"1-1 ZC Fax No. g 11G&'rI"L�7' t e4c
Surety(if any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
n1
Phone No. Fax No.
' 1
Name of person within the State of Florida.other than himself.designated by owner upon whom notices or other
documents may be served:
Name011
Address
Phone No. Fax No.
vJ
In addition to himself,owner designates the following person to receive a copy of the Lienors Notice as provided in
Section 713.06(2)(b).Florida Statutes.(Fill in at Owner's option).
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY , OWNER
BSi pore me this / day of CATS -
County of Duna..State of Flonda parrso'a i• a fired
_...... . . '�1// /�///1(D�
himself-Mrset and affirms that all statemem�nd'6 ratan hvralpM`�a'p I4o COUS� SEES
are true and accurate
` x MY COWISSiON r1 EE 224988
y A~ EXPIRES:August 28,2016
Fcr ns' gook Thu eudgec hotirp Semen
i
Nat -ufica Utah of` . County of
My commissron oxprec
Personally Kno•...n Or
Produced Identification