1057 LITTLE CYPRESS KEY - ROOF (2) A
" \`S\ CITY OF ATLANTIC BEACH
, 1w 800 SEMINOLE ROAD
J 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-3867
Job Type: ROOF PERMIT
Description: RE -ROOF SHINGLES
Estimated Value: $13,789.00
Issue Date: 5/1/2017
Expiration Date: 10/28/2017
PROPERTY ADDRESS:
Address: 1057 LITTLE CYPRESS KEY
RE Number: 172027-5830
PROPERTY OWNER:
Name: NEUBERG TRUSTEE, CARL E
Address: 1057 LITTLE CYPRESS KEY 1057 LITTLE CYPRESS
KEY
GENERAL CONTRACTOR INFORMATION:
Name: RIVER CITY ROOFING
, CCC 1325973
Address: 10650 HAVERFORD RD STE 2 ERIC MITCHELL
Phone: 904-766-3464
FEES:
BUILDING PERMIT FEE $118.95
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
Total Payments: $122.95
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH •
•
• 800 Seminole Road,Atlantic Beach,FL 32233 {{ 7 p `
Office{904)247-5826 Fax(904)247 )5845 ` RUCK F" _ 3867
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Job Address: r,5-- - ' Peait Number: •
.ld dtl 11,e A ,3 '�Pi zerdi' riu
Legal Description . ... ..- ' -.. E ' (4L Parcel# /2-Z a.?2-ysrdf'� _
nor • o Sq. t Sq.Ft
Valuation of Work$.1-3 '? O? Proposed Work heated/cooled noir-beatedlcooled;•
l e-/Addit o Q
Class of Work(circle one): le-
Ad itiorr Alteration Repair M emolidon pooUspa window'
Use of existinglppropposed•structiire((s) circle opt): Commercial Residential
Ilan existing structure,is a fire s rinkler system installed?(Circle one): es o N/A _ n 0
•
Florida Product Approval# /L 7q s /Aele✓./aynr62n FL /5oz t�
For multiple products use product approval * .
Describe in detail the type of work to be performed: 134
Property Owner Information: ,
Name: l F QL/J /ty Address: G�5'• e e' 1
City ; /-Ii ' Ste j_Lip c - phone 1
E-Mail or Fax#(Optional) b./2 1.0 r •Pt s t -J",,c tlle r°re/ ?441? 7 f
Contractor Information.
Company NAme: tai lief <-'' 6jeS-4,7 QuCitalifying Agent: ei___Address: -52/ a• _ArCity , 1' . State&,Gip
Office Phone `, - , 'Job Site/Contact Number 9 4-c9Y'. itc4 47 Fax it 9440— 6-0 9_... 43,c3g
State CertificationfRegistratlon# r P... '-7_3
Architect Name&Phone 4 a/'
Encrineer's Name&Phone# 111
Fee Simple Title Holder Narnc and Address ,t f
Bonding Company Name and Address / A _ — ------ - - —
Mortgage Lender Name and Address. AZ/ ___..
AppL'cation is hereby made to obtain a permit in do the work and insrallotions as indicated I certify that no work or Installation has commenced prior to the
• Issuance o�(a permit and than et work will be pe ormed to meet t standards.of ail laws regulating constrvatton in this furlsdtarlon This permit becomes null
and void',work is no!commenced within Six(6 months,or lrcaasstrue1lon or work is suspended or abandoned for o period iod Cf six(6)months at any time after
worris Comma ced,Conditioners,understand
n se rte d that separate permits must be secured for EieurkCalrWork,,Pininbing,Signs, 1Yclls,Pools, teenaces,Bolters,Heaters,
nd Air
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF •
COMMYNCEMFNT MAY RESULT IN YOUR PAYING TWICE FOR iMPROV]MENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINAtNCZ'�lt 'G, CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
• CO. IENCEMENT.
• I herebycart i4!hot 1 have read and examined this application and/wow the sonic to be true and correct. Ail pravLsions of laws and ordinnneec oaternine this
ops of ork will be Complied with whether specl,,ied herein or not. The granting of a permit does net presume to give autho
authority to violater canter the
provisions of any other federal,Stale,or taco!WI regulating construction or the performance of construction.
.Signature of Owner ..i.,.f! . .. .t._ Sigrature of Contractor /
Print Name c.5„., fit Q gel t%Z.jj A 2 _...(,...121i„0._._44_nt Name if_.._ . '• _____
Sworn to and acs cd bed before me 'See. ^- dSworn to and subscri•ed before i:'iP
'
this�.Day of ,20 J`y-�' '�- this ' l) y of 1, i _ 1 •20/7
Notary Public A
Not uu 1i� _F $tAtlGO!"lrt4ft10V4
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, re ,
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BK 17931 PAGE 1244
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Description of Attached Document .4.
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Doc # 2017075466, 179312
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RECORDING $18.50
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