ROOF BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845
Job Address: 33f, / ,'1T€ s Permit Number:
s Ott Legal Description . t, t2, A41Dv.+ii e 4 Fi �nEhi .uno r � Parcel#
Floor rea of Sq.Ft. Sq.Ft
Valuation of Wo $ Prop. ed Work heated/cooled non-heated/cooled
Class of Work(cur le one): CD Add' on Alteration Repair Move Demolition pool/spa window/door
Use of existing/pro I i sed structure(s) ci e one): Commercial 'esidentia
If an existing struc e,is a fire s s run r system instal 9 ' cle one): o N/A
Florida Product Appr. .1# 17, . .S
For multiple products . •• s i . t approval form
Describe in detail the type of work to be performed:JhRo.11 rev Ale."64 Raf or
Property Owner Information:
Name: 4Cit+11feeri Gni A/t6l5 gall Address: 1(1 OLe ortde-c $4rre4-
City AtePtviw I . y_t, StateFt.Zip32264 Phone
E-Mail or Fax#(Optional)
Contractor Information:
Company Name:Thome, MG.4-o.1 c' 4-e,nS,Z'^C Quali in A ent:
Address: )635I ci'v l voic Sr't+c Akii4 City i& ,c State FL. Zip 32014'
Office Phone ctd{-ahif--(13$" Job Site/Contact Number {-422 -6//1 Fax#gay-tatty-'11340g
State Certification/Registration# Cee-17 Z SE2$
Architect Name&Phone#
Engineer's Name&Phone# f
Fee Simple Title Holder Name and Address 0.71- `�'(�rr1c� �, 10r ne-in Q.:WSL(stems
Bonding Company Name and Address
Mortgage Lender Name and Address . COryI
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 certify that no work or installation has commenced prior to the
issuance ofa 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,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.
/hereby certify that l 'e re• and examined this app at ion and know the same to he true and correct. All' isions of laws a ordinances governing this
type of work will b compile% with whether specified ':rein or not. The granting of a permit does not • •sume to give author' o violate or cancel the
provisions of any o ter feder a 1.state,or local law regula g construction or the performance of construct'.'
Signature of 0 ner Signature of •n'actor
Print Name Print Name
Sworn to and s bscribed before me Sworn to and subscribed before me
this Day s 0 this Day of 20
Notary Public Notary Public
Revised 01.2. 0