574 OCEAN BLVD - ROOF f r,J`l r
J �51
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
yr: 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: 17-ROOF-3005
Job Type: ROOF PERMIT
Description: RE ROOF
Estimated Value: $7,800.00
Issue Date: 1/17/2017
Expiration Date: 7/16/2017
PROPERTY ADDRESS:
Address: 574 OCEAN BLVD
RE Number: 170141-0000
PROPERTY OWNER:
Name: PARK, STEPHEN A & SUSAN L, *
Address: 574 OCEAN BLVD
GENERAL CONTRACTOR INFORMATION:
Name: GREAT WHITE CONSTRUCTION INC
, CBC1256245
Address: 4320 DEERWOOD TRAVIS SLAUGHTER
Phone: - -
FEES:
BUILDING PERMIT FEE $89.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $93.00
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 () - RooF- - 300 j
Job Address: S1 GOD Q t.i � CU4CU' �, � 'r(., Z3 Permit Number:
Legal Description 1W\kle, \ cil mtn, OVA LOYc Parcel#
, _loor Area of Sq.Ft. q, t
Valuation of Work$1%01.), Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): New Addition Alteration it Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial R en '
If an existing structure,is a fire sprinkler s stem installed? (Circle one): s No (12A.
Florida Product Approval # 1W(l4- '(1,
For multiple products use product approvalorm
Describe in detail the type of work to be performed: -( 26 cot (a f
Property Owner Information:
Name: %-'C-e MJC\ 9049..4.-9L Address: 4 DesaVci,
City (Jul(! . C )VI StateZip 1 . Phone �,(y-Y. (41• Gail('
E-Mail or Fax#(Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS: �k° 1.\'\t.-kS6 cccd - ('Co
Company Name: CV U wicac C(1 SJ&rull Qualifying Agent: CLu k `��.�
Address: 437() QQ,/(U�;) LLL L dp 3 City J State Ft- Zip 33ZtZCc,o
Office Phone lD 4rl•in LS Job Site/Contact Number �.( )'k� 2 &o 1 Fax# Up—MU- .)
State Certification/Registration# „C' 137A067
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 of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six(6)months at any time after
work is commenced. I understand that separate permits must be secured for Electrical {Fork, Plumbing,Signs, Wells, Pools, Furnaces, Boilers,Heaters,
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 YOUR NOTICE OF
COMMENCEMENT.
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this
type of work will be complied with whether p ed herein The granting of a permit does not presume to give authority to violate or cancel the
provisions of any other federal,state, . loc. 1 egulatin onstru ion or the performance of construction.
Signature of Owner _ `L G"` Signature of Contractor ��—
•
Print Name 5 7.-- A1-6-,-)2 ' U,910'print Name ' Z kilA l
Before me Befo e I.e
this Dayof J L Y @.3!� W RI , •ham
\ .� . . .. 20 , tl 's •Da of . t• r ��
..-
A.A J.,i IIP" s.Z KRISTINE SANTUS �10' �1i', • PubNC-State a flock,
NotaryPublic k ti Hoar Public•Statc n n I ;kVA^, .•t +. . .
., r Nota public ' ��dd_
l M Commission x GG O s.? p ( -4,8r,:\.,,,, My Comm. Expires Sep 10,2020
•,t-,:"":.(;,.r My Comm.Expires Seo 18 1020
"
Doc # 2016288936, OR BK 17816 Page 105, Number Pages: 1, Recorded 12/19/2016
at 03:47 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00
NOTICE OF COMMENCEMENT
vy'�f� � (PREPARE IN DUPLICATE)
Permit No. t`—1fo-$a IDIS Tax Folio No.
State of /14 R' County of LY/Yet I
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. AlLeg des iptbn of grope mg improved: q De4oa/`r _6/1/D ,
laivita ' �.ct. !`ter 3�z3�
ik#lanClC t3cacX� N112 LAt U tj*s eLva
Address of properly being'mowed: 1 e
}/,¢N}t`v t eA- i231r 3 z 2-3 3
General description of
iimprovement�s:,,y ,- ,'
Owner ss Q �l•S"� blva ,L.c bake gli 3Ze33
Address i /V/r
Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
ContractorC Wt Li'l. Vihhi�tt. /Or�'fY1rUC tl0h
Address 43a0a��yaf.�.wtocC( lade .bac`rl.e=1.tp
Phone No.c:10'-t CO lZas Fax No. FICA U. Iy LNC
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 served:
Name
Address
Phone No. Fax No.
in addition to himself.owner designates the following person to receive a copy of the Lienors 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 horn the date of recording unless a
different date is specified):
THIS SPACE FOR RECORDER'S USE ONLY
ski ` DATE/2.-/2.--/C-,6/S—
Before of YPG4.11(be C --h he
Cox II.St DMfmalY +..++'
?Uwe UNDERWOOD
NriniNNW vat affirms out staWmrnt�and
ere trga area accaas =ti a MY COMMISSION A 043030643
Iy�y,I �. EXPI S 0010ber 04.2020
No�ry NM at Large.state s ( .County of
rr1,,,(tdd///commission expws:
PeProaxr> ad CyK"°""—m— 11
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