178 Beach Ave 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 NE7tT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ROOF-2621
Job Type: ROOF PERMIT
Description: FINAL ROOF INSPECTION TO REPLACIE EXPIRED 15-
ROOF-1548 ,METAL ROOF ON IST FLOOR
Estimated Value: $8,000.00
Issue Date: 11/22/2016
Expiration Date: 5/21/2017
PROPERTY ADDRESS:
Address: 178 BEACH AVE
RE Number: 170210-0000
PROPERTY OWNER:
Name: 178 BEACH AVE LLC
Address: 6 E BAY ST SUITE 500
GENERAL CONTRACTOR INFORMATION:
Name: RON RUSSELL ROOFING INC
Ronald Wayne Russell,CCC1327484
Address: 4419 HUDNALL RD QA RONALD WAYNE RUSSELL
Phone: -
FEES:
BUILDING PERMIT FEE $90.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLOMA
BUILDING CODES
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233 (�
Office(904) 247-5826 Fax (904)247-5845
Job Address: 178 Beach Avenue.Atlantic Beach,FL 32233 Permit Number:
Legal Description _"QQLot 5 Block 31 Atlantic Beach FloorAreaol PB 5 page 69 Parcel# 170210.0000
Valuation of Work�'r0�0•Of Proposed Work heated/cooled 21? 1 non'heated/cooled Z4 S t
Class of Work(circle one): New Addition Alteration Repair Move Demolition pwUspa window/door
Use of erdsting/proposed.structure(s)(circle one): Commercial Residential
If an existing structure,m a fire sprinkler system installed?(Circle one): es o to /A
Florida Product Approval # fiL //S C.a - 4f
For multiple products use prpr ucto�appr�Torm
Describe in detail the type of work to be performed: Jam i � Tawe `^s S+awdt.1 < -
21) 22 .12 Mlf� — ft w..lct:,.1 NA.FrI P+�Q •w /� 54•'�
Property Owner Information:
Name: 178 Beach Avenue LLC Address: c/o David Edwards,200 W Forsyth St.,Ste 1300
City Jacksonville State FL Zip 32202 Phone 904-699-5333
E-Mail or Fax#(Optional) dedwards@edcolaw.cont
Contractor Information:
Company Name: e n Qusfe 11 �,.M1•M Tne Qualifying Agent Qon.lr� pusre l�
Address: yNKt }l..dH,.tl K.l City �..� S[a[e Ft. Zip 72%ol
Office Phone IVY-71-1-110'1 Job Site/Contact Number Ao o -SsB S Fax#
State Cenification/Registmtion# CCC /32-1944
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 o(a permit and thin all work will be performed to meet the standards of all laws regulating construction in thi junsdictim This permit becomes null
and void t work is not commenced within six(6)months,or ff construction or work is suspended or abandoned for a period of su ti)months at any time after
work is commenced. I understand that separate permits most be secured for Electrical Work,Plumbing, Signs, elle Pools, Parnaces, Boders,Healers,
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 YO'IJR NOTICE OF
COMMENCEMENT.
I hereby certify that I have read and esamined this a plication and know the same m be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether street ted herein or not. The granting of a permit does not presume to give authority to violate or cancel the
provtstansofanyolherfederol ort p mPR tutting construction or theperformance ofconatuction.
Signature of Owner
� > Signature of Contractor
er
Print Name .11LI.YId. J-- .3d t1 yaY� f)............._ Print Name Ref--1 ...4 srstI.L....-----......_....._........
—
Sworn to and subsc�nhr ore{nee Sworn to and subscribed before me
this fMay of e fd'.✓ .20 ITMJ this r?Day of JIJ «w.e .20 /4
Notary Public No Clic
Revised 01.26.10
RQlE ftrlBaEILY Ryan Re inkk EyrIck
ewiitig� NOTARY WSLIC
MrcaMWION/FFe STATE OF FLORIDA
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