646 Selva Lakes Cir re-roof permit �I
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: 17-ROOF-3297
Job Type: ROOF PERMIT
Description: re-roof FL10124.1
Estimated Value: $7,000.00
Issue Date: 2/21/2017
Expiration Date: 8/20/2017
PROPERTY ADDRESS:
Address: 646 SELVA LAKES CIR
RE Number: 172027-5802
PROPERTY OWNER:
Name: Stewart, Alex
Address: 646 Selva Lakes CIR
GENERAL CONTRACTOR INFORMATION:
Name: JUSTIN LARSEN CONSTRUCTION INC
Justin Earl Larsen,CCC1329847
Address: PO BOX 1942 LIC # BELOW 4 GERALD GOLLOBIT
Phone: 904-327-4311
FEES:
BUILDING PERMIT FEE $85.00
STATE DBPR SURCHARGE $2.00
STATE DCA SURCHARGE $2.00
Total Payments: $89.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH DATE
s �J 800 Seminole Road,Atlantic Beach Fl,32233
'' /Itt ec__
Office:••(904)247-5826 • Fax:(904)247-5845
Job Address: �'tlo �.7('[-j& t_.iaktS C/e- Permit Number: ^4D F-32: 14
Legal Description O Se 1A WLC5V--t3 RE#
Valuation of Work(Replacement Cost)$ _Heated/Cool¢ F Nan-linted/Cooled
• Class of Work(Circle one): New Addition Alteration Repair ove Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Comme Residential
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No
• Submit aTree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
U ' FW�
Florida Product Approval 4 KI I O 1 y. I for multiple products use product approval form
Property Owner Information
Name: 100 S�t..w'�-'� Address: (O4 �eIvA �AtitS 62
CityAN� t� StatcElZip3Z233 Phone '3}O- �F�F- 4SL4
E-Mail
OWoerorAgent (If Agent PowerefAaomeyorAMU LWerReq
uvMl
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 NOYEE OF COMMENCEMENT.
Contractor Information: ,( - �
Name of Company: ��14Sta-J l .'Qt6+Catl7�J Qualifying Agent: J'J S+i J LAyw4
Address: ql h,A01rera4t46- StamKip L4p6S-
Office Phone Job Site/Contact Number
State Certification/Registration# 00 E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Worker's Compensation
xempt insurer ease rap ayees xpimhon ate
Application u hereby made to obtain a permit to do the v .tallations as indicated. I certify that rw work or insml/anion has comm¢ d
War to the issuance of a permit and that all work will be performed m meet the standards of all laws regulating construction is juris Y n.
Phis permit becomes null and void if work is not commenced within sic/61 months, or if construction or work a sus a and ed r a
period o sax(61 months at anytime after work is commenced. 1 understand that separate permits must be securedfor emi I W ing
Sign lls,PPools,Furnaces,Boilers,Hearers,Tanks and Air Condaiours,eta
Vee
Signature of Property Owner`: X �!✓ Signature of Contractor:
Befo e
this Day of Before me this D of
Notary Public: t•' Notary Public:
,. p1 CompissnnI FF 214797 OP.
DAVID NAT SLAT04
I herebycern that! uliel 'on and know the same tol�p inv and
ordinaces g erasing ha n tm'
ah
whether speci ted he 'Th r tpp�� tes of
presume to give autho r v e ar cant a provisions of any other fe eral, at ]F.YJ1i t HI7riQV9a or the
performance of constmrcYion.