75 10th St roof permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
r" INSPECTION PHONE LINE 247-5814
ROOF PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-ROOF-2826
Job Type: ROOF PERMIT
Description: RE ROOF
Estimated Value: $5,990.00
Issue Date: 12/19/2016
Expiration Date: 6/17/2017
PROPERTY ADDRESS:
Address: 75 10TH ST
RE Number: 170263-0030
PROPERTY OWNER:
Name: MARK, FORREST H
Address: 2833 SINKS CANYON RD
GEN ERAL CONTRACTOR INFORMATION:
Name: QUALITY DISCOUNT ROOFING LLC
Roger D.Zeigler,CCC1329885
Address: 1794 ROGERO RD
Phone: 904-396-5000
FEES:
BUILDING PERMIT FEE $79.95
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $83.95
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach, FL 32233 (�
Office(904)247-5826 Fax(904)247-5845 (q - 1 o0`�— z8 z �O
Job Address: 75 W 10th St Atlantic Beach FL 3Z23, Permit Nignber:
Legal Descriptionix
%p3T ye r-x E / / e �t15 r e1# /7�//" 00U�
oor Area o
Valuation of Work$,SGG/�. UO Proposed Work heated/cooled 1152 non-heated/cooled
�Raepair
Class of Work(circle one): Addition Alteration Repair Move Demolition pooVspa window/door
Useofexisting/proposed structures)(circle one): Commercial esidenfi
If an existing struclture,is a fire sprin er system installed?(Circle one): o N/A
Florida Product Approval #
For multiple products use product approval form 1
scribe detzjl the a of�vorkto be pelt'ormed: Net be' installed t p�gperty 1
a.G ` 02s OVR- \ t. - It y
Proaerty Owner Information: leo . 1
Name: Desiree Lesko ss:206 N Berne St.
City Schuylkill Haven State PA Zip 17972 Phone 717-350-2848
E-Mail or Fax#(Optional) desireenevAmnail.com
Contractor Information:
Company Name: ualit Disc m Roofing Quati vl A end QWO b'
Address: 1 1)90CAINI- W State Zip
OfficePhone b -' OO O Job Site/Contact Number Fax#
State Certification/Registmtion# CLL 134j $�l
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address Evor(,au, k Za%cksoa,v(Ile- FL
Application is hereby made to obtain a permit to do the work and installations as indicated I certify that rm work or irmallafim hos commenced prior to the
usuaree o//a permer and that all work will be perjormedto meet the standards ofalllaws regulating conshuction in this jurisdiction This permit becomes null
ondvoid7work u not commenced within six(6)months, or ifemystmction or work is suspended or abandoned for a eriod ofsi,, 6)months at any rose atter
work is commenced. I understand that separate permits must be secured for Eleadd Work,Pbmbing,Slgm, F�'ers,Pools,1!umaces,Boilers,Healers,
Tanks andAlr Condidoners,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 YOUR NOTICE OF
COMMENCEMENT.
lhere certify that l have read and examined this ayplicashmandknowthesametobenueardcomecG Allproviriom oflaws and ordtwxes governing this
type aJ work will be complied with whether,Te�ined herein or not. Tile growing of a permit does not presume to give authority to violate or cancel the
provisions ofany otherfederal,state,or/ata law regulating construction or the performance ofcomtmction 1
Signature of Owner Signature of Contractor -V '7 �—
Print Name ......�5]. gf...........(..tS�o......._...._..._._..........._..._.... Print Name ..1�p'Y�tf�Y_... .._GrL4L. ....._........_.
Swam to and subscribed before me Sworn to and subscribed before me
this 'Z7 Day of Noun--b-W .20/4 this 1,2 Day of ,DaA n htr .20/6
may Public NAME I.IA%l ..S M d FWWa
M.ayPWat-finl Florida
a ►
eummissail I FF 227615
Cassano FF 227615 Revised 01.26.10
? Li My Comm.Expires May 5.2919 • Yr C'".joss,Many5,2919
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Doc M 2016283518, OR BK 17808 Page 286, Number Pages: 1, Recorded 12/13/2016
at 10:35 AM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00
NOTICE OF COMMENCEMENT
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CONMENCEMENT.
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