2139 Seminole Rd roof permit S y1�1r
CITY OF ATLANTIC BEACH
Y 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
706 INFORMATION:
Job ID: 16-ROOF-2819
Job Type: ROOF PERMIT
Description: re-roof 1956.3 & 13857.4
Estimated Value: $6,900.00
Issue Date: 12/16/2016
Expiration Date: 6/14/2017
PROPERTY ADDRESS:
Address: 2139 SEMINOLE RD
RE Number: 169515-0500
PROPERTY OWNER:
Name: SCHAFFNER, MARYANN
Address: 2139 SEMINOLE RD
GENERAL CONTRACTOR INFORMATION:
Name: ROMANO BROTHERS ROOFING, INC
,CCC1328893
Address: 1188 N 12TH ST QA DANIEL JOSEPH ROMANO
Phone: -
FEES:
BUILDING PERMIT FEE $84.50
STATE DBPR SURCHARGE $2.00
STATE DCA SURCHARGE $2.00
Total Payments: $88.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
Doc 161612:21p Romano 9042464810 p.1
BUILDING PERMLIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5945 1
,bob Address•
`�'' '•: - ��' � Permit Number:
Legal Description ParrelW
Valuation of Work S p0 [ ed Work h4eated/eooled f .� - 9
_ non-h cooled
Class of Work(circle one): Neal Addition Repair emolition pooll window/dow
Use of a dstin�(pro sed strven
sfr Po re(s) circle one): Commercial d 1
YF an existing u re,is a i-re,�Yri r m installed?(Circle Dere): Yes o NIA
Florida Product Aouroval" ((�. ) 3L��•l�
For multiple products use p inIcl appro orm-
Describe in detail the type of AV+to be performed: I�
II
Prooerty Owner bnforaaatioa:
Name• lL( n-N a S� I,r� r r Adareaa: 313 5r_
City I Zin :a2a�hwe
E-Mail or Fax# Optional'
Company N Qual' Agan , n l l r <
Address: 1 . City Sta(e Tap
Office Phone - Job S' Contact Number Fax#
Stater Certificatioo/Regisa uonff
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Architect Name&Phone# I
Engineer's Name&Phone#
Fee Simple Tdk Holder Nameand ddress
Bonding Company Name and Ad ss
Mortgage Lender Name and Address `
Applicatiaepagwts madetoobtaina X' to do rhe workunde sitahara.ratil kniw s l eingcthemwork th!n<tok tl nhasnsminmaeb"ungg the
ind wiaojj'a wmdt andfim allwwk ui!!be mrJanned to mir urntandardw ofdl is Pg regaed.M, oandoin ttg-a0 a(s lrHaa. 7hisperm!t becomes id
and vold ijwoprk Eo not eommencedirlt/do itr(a)monthc or ifcarubme!lai orirark as s+a ndedorab6iWSifora n,,, A r6)manUss� �tg
trakis comnmmN. f m+dmsta+d drat aeparan permits mart be secured fm Elealrien�ipak,lNaarbing,S?g>a, fP'dls, areata,
Pants ardA r Coudldaners,ac
WARNING TO OWNER: YOUR FAILURE TO RECORD A Nill ICE OF
COWEVIENCEPENT MAY RESLTLT IN YOUR PAYING TWICE FOR I 4PROVEMENTS
TO YOURPROPERTV.IF YOU INTEND TO OBTAIN FINANCING cONSUTWYM
YOUR LENDER OR AN ATTO O NFO RECORDING YO NOTICE OF
CYalherdn wfo;that l hate read and"aminedild appinsNou and Muir tha suing in be im andccungat Allpravtsrons err;andordww=sgovernmgtht
of work will b, con plied,crit vJuthgr.rpeS', in m + Ther ynnnng of a parnW doer noipmMi a to aihmity to vidate err rmesl thi
Xislmts ofmry allrerfederal,state, dcolim r w letter+M,dte perfarMw,-afcom+traa'don.
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Print Name ��' _r ,C ��r _ns! PriutName - n 1 c n
S d sub s�lay ofbef rents 0 this Day of be .2Q t
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Dart 161612:21p Romano 9042464810 p.2
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