1929 Main St re-roof permit 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-2376
lob Type: ROOF PERMIT
Description: NOC REQUIRED - re-roof
Estimated Value: $5,200.00
Issue Date: 10/21/2016
Expiration Date: 4/19/2017
PROPERTY ADDRESS:
Address: 1929 MAIN ST
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: Palm Island Homes, Inc.
Tommy C. Lopez,CCC1329450
Addrew: 2294 Tyson Lake DR
Phone:
FEES:
BUILDING PERMIT FEE $76.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $80.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WIM A1,L CITY OF ATLANTIC REACH ORDINAPiCES AND THE nORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEAcm
800 Seminole Road,Atlantic Beach,Fl,32233
Office (904)247-5826 Fax(904)247-5845
114— 40 -Q\'�16
.Job Address: 1999 M,91,j S7 ArLorjj6l� Bwell 3;?2��3 Permit Number:
Legal Description Parcel
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work 12,00 Proposed Work heated/coolled non-heated/coolled
$ �19
Class of Work(circle one): New Addition Alteridion GD Move Demolition pool/spa window/door
Ptesidential
Use of existing/proposed stmetures)(circle one): Commercial
If an existing structum,is a firesprinkler system installed? (Circle one): Yes No (�ED
Florida Product Approval 4 FL 19 5� 3 S7AwW_0 ri
For multiple products use product approval form
Describe in detail the type of work to be perfortned: RE-lecuqF_
Property Owner Information:
Nam&* Address: 7—
city 6,41 Jf e State - Zip.5�Phone Z;!_'s N�
E-Mail or Fax#(Optional)
Contractor Information:
CompanyName: PRIM Tjdat�r> I-L�4 -1�ej� QualifYingAgent: -Tn—m�! c� L_opcz-
Address, 7VIq LJ142? Z!ir City State zip&&?_�'
Office Phone 9VMV- 60F'C'— Job Site/Contact Number Iz-e- -3-Kro Fax#
State Cartification/Registration# CCC- 137- 9'IS-O
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and
Address
Bonding Company Name and
Address
Mortgage Lendff Name and Address
Applicalum is hereby made to obtain a permit to do the work and installations at unificated I conify that an work or installation has commenced
Tor to the issuance of a permit and duot all work will be d to meet the standards of all laws regulating construction in this jurisdiction.
b V=8
his permit becomes null and void if work is not commence within set (6) months, or if construction or week a suspended or abandenedbt,a
period�six(P monthv at a"time Oer work is comeenced. lunderstandthia separate permits most he securodfor Ekc&icd Work;Pharibing,
Signs, efis ol&Fu�BoUemffeaemTmksandAirCondftionem�
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.
aulhffi�y to
Signatureofowner Signature of Contractor
Print Name Print Name ww�
scrri
me Swo to and subw f
this /)20& thi Of .20
v No*!�iblyr
Revised0l.w.10
e"% IZABE
yo, SSIONO ELIZABETH NOS-LOPEZ
MYCO�SSIGNOF
:F ak2m Jw'
F�
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. Aq - Q00 F- 23 '76 Tax Folio No.
Stated rjoP-�OA County of D41."q-
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.
Legal description of property being improved:
LOT q
Address of property being improved:
19.19 (Y)rnf'.1 S-1
General description of improvements:
kC - P_C)OF7
Owner Ary�0 (�y f�'JO 2-
Address M*1-0k iw%po:,�s s—, ft1A-rJnC- Q�&AC�, i:'lo e cA 3-2--L3
Owners interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor.PpArn -rstt",sC. 14o��s �N�
Address ZV�q -r-Zl�o,4 L-Ak� tr-I-Ptorl 37--Z7- 1
Phone No. 10- / Z� Fax No.
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
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 sewed:
Name
Address
Phone 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 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
signed: DATE
-�/' day of D I , /
Do,4 2016242982,OR SK 177K Page 2309, Before me tirs
N.mw pages.I Cd� I State
201 a at 01 39 PIA, lVf !�)
,pnell
Reourded Ao2lj COURT DUVAL i7l herain by
Rorrnie Fussell CLERK CIRCUIT hensels'herself and affin.that all state'rnerals anddiial
COUNTY tr.e and aomrste ERR
RECORDING$10-00
24.I=
am-a U If Urge,%afte of V=I It County
mycom shon expire 1�
Personal ". .1
n
Pmduce Identificab. R 17 Rigil R 1 1409 1
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