720 Selva Lakes Cir re-roof permit S r rI
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-1908
Job Type: ROOF PERMIT
Description: RE-ROOF , SINGLES
Estimated Value: $10,024.00
Issue Date: 8/22/2016
Expiration Date: 2/18/2017
PROPERTY ADDRESS:
Address: 720 SELVA LAKES CIR
RE Number: 172027-5842
PROPERTY OWNER:
Name: WILLIAMS B/E, PHILIP L, '
Address: 720 SELVA LAKES CIR
GENERAL CONTRACTOR INFORMATION:
Name: ROGERO &WILLIAMS ROOFING CONTRACTORS INC
Address: 883 Lawhon Or ST
Phone: 904-518-5463
FEES:
BUILDING PERMIT FEE $100.12
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $104.12
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORmA
BUILDING CODES.
BUILDr G PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233
Office (904)247-5826 Fax(904)247-5845 CO –R O F • 19c)(5
c)(5
.Job Address:Dan C 1 Un I r,ITss. i�afrelt AP) FL 3903 Permit Numbers
Legal Description CAW, C LnsF oor t+ea3 Lot IZ� Parcel# tlqq bo
Ft
Valuation of Works I pn Proposed Work hpted/cooled 1:7,0_ non-heated/cooled a0
Class of Work(circle one): ear Addition Alteration Repair Move Demolition pooVspa window/door
Use of existing/pmsed structure(s)(circle ooe):• Commercial Residential
If an existing structure,is a fire sprinkler system Installed?(Circle one): Yes No N/A
Florida Product Approval# 'FL-19 b74-40 Ur)Arlt.At,, rA--W FL IS-LI &
For multiple products use p–roduct approval toren I1"
Describe in detail the type of work to be performed:RQ r0 of
`1 I F;4t k Sh na lr s
Property Owner Information: c` "� I
Name' VIf E lniA W, � IM�'15 Address: /7x >LI
0 , VCL LGikz,-� 04-
City
rCity_ n State lZip 322.57 Phoneo .2
F,-Mail or Fax#(Optional)
Contractor information: ((�� ",�''�
Company Name: 0 r fi -� `tk S fpJ Quali ing Agent: .JL'�f"ter� (9
Address: 3 1 S r City L 9 F Zip 2
Office Phone gQ •Sl Job Site/Contact Number OD Fax# D (o- 11
StateCer• r m tray # CC 133 Cap
Architect Name& Phone#
Engineer's Name& Phone#
Fee Simple Title Holder Name—and Artless- L k'At •m..,S 341 S Kyr•
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. 7 certify that no work or installation has commencedpriar to th
usuanre of a permir and that all week will be r(armed to meet the standards ofall laws regulating eonnrsepon in thulurisdtcttan. Thu perat mit becomesme amd
and void f work a nm commenced within sic 4 months. or ifconstruction or work is suspended or obandonedfor a period aftix/Y)� BalersttHeden
work is rommenced. l understand that separate permits must be secured for ElMricaf Worlr,PWmbatg,Signs, fVlte
dfs,Poals,F
Tanks andAir Cren idoners,em
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO OUR LENDER OR AN ATTORNEY BEFORE RECORDINGIYO[JRCONSULT H
YOUR PROPERTY. IF YOU INTEND TO OBTAIN NOTICE OF
COMMENCEMENT.
hereby ceriifv that f have rex and examined thu plication andknow lhegsame bef,rru and correct All rovisions afluws std wdtnances Xmnrn,
,pe mark will be complie with whether sped red herein ar not The rami o permit does now presume ,give,autharit_v to violate or car,
ua u(on}other jeder .slate. or Iecal law r la+inX construction ar the pew rmorsce ojmnrmunion.
Signature of Owner Signature of Contractor
Print Name r Print Name ..._.... .._. ........ .. ......_._....__..__.__ _
.I�_11. ' ...__ W j LLL
.Lams_......_
Swor(�to and subscrihed before a Swo tp and subscribed before me 20
this Aa Day of (-1'V 20 ( b this ptAnay of
jc,/
\o,a, Pubii.: w /AUL ROBERT CASSETTA Notary Yu PAUL ROBERT CASSETTA
commissions FF 1811 Y CommisaiW` FFapx B 6 U
My commuvon Expires ® MycOonin. t�'EWu9.2
e.., July 24. 2017 n„+ July 24. 2017
i
Doc 1 2016187854, OR RE 17672 Page 1253, Number Pages: 1, Recorded
08/15/2016 at 01:22 PN, Ronnie Fussell CLERK CIRCUIT COURT DUV. COUNTY
RECORDING $10.00
NOTE OF COMMENCF=NT
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