145 Pine St 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
JOBINFORMATION'.
Job ID: 16-ROOF-2672
Job Type: ROOF PERMIT
Description: re-roof
Estimated Value: $4,000.00
Issue Date: 11/29/2016
Expiration Date: 5/28/2017
PROPERTY ADDRESS:
Address: 145 PINE ST
RE Number: 170635-0200
PROPERTY OWNER:
Name: WELLS ET AL, JOHN BENJAMIN
Address: 145 PINE ST 145 PINE ST
GENERAL CONTRACTOR INFORMATION:
Name: JUSTIN LARSEN CONSTRUCTION INC
Justin Earl Larsen,CBC1259933
Address: POBOX1942 LIC# BELOW 4 GERALD GOLLOBIT
Phone: 904-327-4311
FEES:
BUILDING PERMIT FEE $70.00
STATE DBPR SURCHARGE $2.00
STATE DCA SURCHARGE $2.00
Tow Payments: $74.00
PERrAn Is ApFBOVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERmiT APPUCA11ON
Criy OF ATLANTIC BEACH
o" 800 Seminole Road,Atlantic French FL 32233
Office:(904)247-5826 - Fm:(904)247-5845
Job Address: plj'� PermitNurriber:
(Of �&)' RE#
Legal Description '�A- L+Ate- S-ec -3 ;5,
Valuation of Work(Replacement Cost)$_*0_0Heated1CooIed SIT Non-Heated/Cooled
Class of Work(Circle one): New Addition Aitcmli(n��Re�pair 'am Pool Window/Door
Use of extsong/proposed structure(s)(
am
Circle one): Commercial Residential
If an existing structure,is a fine sprialder system installed?(Circle one):IRS N/A
Submit a Troc Removal Permit Application if any trees am to be removed or Affidavit of No Trm Removal
Describe in del 'I th type f tk to be performed:
427 Zflyo
Florida PnoductApproval# 0 far multiple products use product aprurroal loan
Property Owner Information
Nam 1+ Address: /1/5 P)JU<— S*-
city Statjj- _Ztp -Z Phone
2ZU
E-Mail
OwnfforAgent (UAenr,Powvrof)at�qt,A��
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 NUTZE OF COMMENCEMENT.
Contractor Information:
Narne of rnpanwf��'�j LAqseJ ea��At�� Qualifying
Address: tie y )L4100) F6- State Zip LisfaW
Office Phone Job Site/Contact Number 3z��—Lljltf
State Certification/Registration#0E�A!j,;t E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workees Compensation c5re�� Exernpt insurer / wic lNnployees I Expiration,Date
anced
!a..
to
-91
iX
1herebycenif Ihmerea, kn thesontetobel I III wxv OFF(,, It
j that I hm:c r�,u Won't
ordinances gommir this 11pe a it"t 111118 spelvd,ir,rein E' I
f, ,
presume to gim out ori(v tb vio le up cancel the P.,11 c e.I 'ha'.
petforrvance of consuvoinn,
NOTICE OF COMMENCEMENT
State of 119& County of Tm Folio No.
To Whom It May Concern:
The undersigned hereby inforrus you that improvements will be made to certain mat property,and in accordance with Section 713 of
the Florida Statutes,the following information is stated in this NOTICE OF CO MENCEMENT.
Ugai Description��Zb i g;p to -(6 V
roved, —i.I
Address ofproperty being improved: PI t-c- A+L4,A'C- -Re-evo- pq, -:vLZZ3
General description ofimprovements, V,�'�11
Owner--'O L�o r� jeAlS Address: i4s- Pt"e,
Owner's interest in site ofthe improvement:
ee Simple Titleholder(if other than owner);
lConuk' Name:
act --T;�-
or
Address: ltb3�? kc�JAZ)q �a- f-".
Telephone No.. Fax No:
Surety(ifany)
Address: Amount ofBond$
Telephone No Fax No:
Name and address of my person making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name o6e-non within the State of Florida,other than himself, designated by owner upon whom notices or other documents may be
served: Name:
Address
Telephone No: In 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 ofNotice of Commencement(the expiration date is one (1)year firom the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Date: 13
Sirrcrn&+lris,— x-Idayof ktAIRA� intheC�b0fAl'stat:
13 In .7z Z:�/�
Of Florida,has personally appeared-j)sh'A W .VRM
Personally Known: or
Produced Identill
Doc#201627ISG1,ORBKI7791 Pae,1281, Notary Public
Num�Pages:I My commission expire ULANGNI
Recorded 1 IM/201 6 at D�A 3 PIVI.
Rwnte Fussell CLERK CIRCUIT COURT DUVAL CDrMJ'n;00F'F&1041"FbWft
I, ,
COUNTY Ady mt..a Ples Aog.10,2018
RECORDING$10.00