499 Selva Lakes Cir 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
JOB INFORMATION:
Job ID: 17-ROOF-3437
Job Type: ROOF PERMIT
Description: ROOF FLASHING AND CHIMNEY REMOVAL
Estimated Value: $850.00
Issue Date: 3/8/2017
Expiration Date: 9/4/2017
PROPERTY ADDRESS:
Address: 499 SELVA LAKES CIR
RE Number: 172027-5038
PROPERTY OWNER:
Name: WRIGHT, NORIANNE
Address: 499 SELVA KLAKES CIR
GENERAL CONTRACTOR INFORMATION:
Name: JAX ROOFING
,CCC1330807
Address: 601 ABBEY CT DR CA JAIME TULIO CARDONA
Phone: -
FEES:
BUILDING PERMIT FEE $55.00
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $59.00
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
Phone:(904)247-5826 Fax:(904)247-5845
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Job Address: ,,g8 c, ^(� /Pe_rmt�it Number: -�L�-1-7 �Fy�[�
Legal Description "tI -515 (1_2 ) -d-IE �Vc1 4Jf �V REp N .�/,c,l _JV✓LJ
Valuation of Work(Replacement Cost)5 R50 Heated/Coaled SF Now Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree 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:
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Florida Product Approval# for multiple products use product approval form
Property OWar1f �ma�ti
Name: . F'% �-r_ IV'gIwNt Addre �Gi J LI
city State TJ Zip Phone
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) -I'
Contractor lnfonnatfonTUK 910 1 `/- Oualt �1Q1f V.IFOLU's'
Name of CRRm ny: �JJ e-1�, l fyinB Agent:
Address h2b 1\ I�rU City 0.(KbOftVl f.State Zip
Office Phone� -1 Job Site/CQptact If1C7•(� o
State Certification/Registration# E-Ma# Jpj EXT
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation r 15r ,c ev t(,1 2A1(8
pt/Inwrer/Lease Empbyees/Explrrtion Date
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 the laws regulationg
construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc.
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
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 YOU TICE OF COMMENCEMENT.
tj1pimne of Dwoff or Agent including Contra r) ISignatureof Contractor)
Si ed,1and swo n to(or afFlVbefa me this da� f Signed and sworn to(or afNrmed)before this S d of
n � by r—wr1.. zol by 1e of Notary (!jignirtule of Nola
�"4. MAMA UICRECIA CIOIDONII
#A"ws,..y MARIA LIICRECIA CARDONA My CoMxnSSIDN#FF1rnP2s
V( •= My COMMISSION OFF]Inns EXPIRES Dctober 21,2020
( ]Personally Known OR . Ty 1 ersonally Known OR
] l Produced ldendOcatl EXPIRES O,tWer 21.MRS Ilproduced ldentmlcatlan Ian�seu�v Fw,�mNa• sense.c•m
Type of Idem#Icatlon: +mI�ea'as Mria Nnu sence.cmn Type of Identification: