376 10th Street REROOF CITY OF ATLANTIC BEACH
j 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-2290
Job Type: ROOF PERMIT
Description: RE ROOF SINGLES
Estimated value: $6,875.00
Issue Date: 10/12/2016
Expiration Date: 4/10/2017
PROPERTY ADDRESS:
Address: 376 10TH ST
RE Number: 170053-0000
PROPERTY OWNER:
Name: LUCERO, MICAHEL & LESLIE LILY,
Address: 59 N 19TH AVE
GENERAL CONTRACTOR INFORMATION:
Name: SHORE ROOFING COMPANY
,000054811
Address: 914 7TH AVENUES QA THOMAS LOUIS SHORE
Phone: -
FEES:
BUILDING PERMIT FEE $84.38
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $88.38
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
N
CITY OF ATLANTIC BEACH
800 Sermonic Road,Atlantic Beach FL 32233
-ort v?
Office-(904)247-5826 • Fax:(904)247-5845 I (Q —R
1 ooF. zz9h
Job Address: 375 /yll'h ST Permit Number:
Legal Description$26,j /G-aS-dSE ,/y 4f/Rvjrc. 13nc 1.Lal-Ta # /70053-000p
a.
Valuation of Work(Replacement Cost)S-6ps Heated/Cooled SF Non-Heated/Co sled
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structures)(Circle one): Commercial Residential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees areto be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
Re-ROOF C sec, jr�Rrm�'oS) 5lrf Ara r217/V "'3" '•" I
Florida Product Approval#1/S` ,Z r0Q for multiple products use product approval form
Property Owner Information
Name: Uc.t1'd Address:
City 3wx f3ra� Statef[Zip ZVO Phone 1f Ly-074 f{
E-Mail
Owneror Agent (nAgmt,PowerofAftmM mAgeooyl.eaer RsquiiNl
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 NOTIC7E OF COMMENCEMENT.
Contractor Information:
Name of Corn any: .Aorc. 1264 A'r C 6- Qualifying Agent: '7&MAtl Aar e
Address: 130 U 'I n ✓r r R City ST 06kK StqRZip 326 fa
Office Phone Job Site/Contact Numbe
State Certification/Registration# 12CfdWg1tll E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Worker's Compensation
xempt usurer a rap oyees xpirhon ate
Application is hereby made to obtain a permit to do the work and installations os indicated. Icertiify that no work or installation has comme id—
War to the issuance ofa permit and that all work will be performed to meet the standards ofall laws regulating construction in this junsdic lag R
is permit becomes null and void if work is not commenced within six(6 months,or if construction or wark is suspended o abandoned r &
period o(si,%)nunths at any done after work is cammenced. lundersta thatsepamtepermirmuetbesecuredfor tlecrriciWork,Plum
Signs,Nie/Ls,Pools,Furnaces,Bo�mlsAY Conditioners,era
'Signature of Pill
roperty O Signalre of Con [or: w I
Before e p
this_yDay of M W Before re this
1:-e
Notary Notary Publ' . e '.¢
I herebv r ;'' yy,,��0.7 application and know the same to be true and correct. All provisio o ( -
ordinanc< uil biplied with whether specs(teof herein or not. The granting of a pe nes no[
presume a.n iry th rovisions ofany other federal, state, or lata(law regulating construction or the
perforao,
Rev.3/14/16
NOTICE OF COMMENCEMENT
Stateof Oct Countyof /Jv.At Tax Folio No. /70053-CO°d
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. y
Legal Description ofproperty being improved: S-6Q 167 .5 -196 .l`1 AF(RA#jc, 13e,c . L043SdZk, 12.
Address ofproperty being improved: 376 10—A ST firic r 1-1
General description of improvements: Rc IZOO 1 t
Owner: jml)rG / VGc(/) Address: -trl IWc. J xF;rK.hf'73
Owner's interest in site ofthe improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: S)V*-AW
rCd
Address: 430y;111ytf-do r2 ! j l=1 ?2080
Telephone No.r'6'(O —AgI —$$Nil Fax No:
Surety(if any)
Address: Amount ofBond S
Telephone No: Fax No:
Name and address of any person making a loan for the construction ofthe improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other documents may be
served: Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone 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
xSigned: �� Daze: 76 /!5 A
Befo a Ihis ay of in the County of al,State
MMEIA JEAN SNORE Of Florida,has personally appeared
N1WF NGk CUis al Falba Personally Known: or
MY Coen.ExOne;Da 4.2017 Produceifiyy —.S.VO—YO—YL((1
OeeMEMn•FF 074537 Notary Public: ff
My commission expires: /
Doc#201623a131,ORBK17736 Page21g5.
Number Pages:1
Recorded 10/12/2016 at 11:55 AM.
Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING$10.00