326 19th St re-roof permit D' 9
CITY OF ATLANTIC BEACH
°' 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF17-0035
Description: RE ROOF -SHINGLES
Estimated Value: 18000
Issue Date: 7/12/2017
Expiration Date: 1/8/2018
PROPERTY ADDRESS:
Address: 328 19TH ST
RE Number. 172020 0904
PROPERTY OWNER:
Name: MONTGOMERY LESLIE
Address: 328 19TH ST
ATLANTIC BEACH, FL 322334538
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: Revive Restoration Corp
Address: 2890 UNIVERSITY BLVD W
JACKSONVILLE, FL 32217
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
Building Permit Application
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FL 32233
' Phone:(904)247-5826 Fax:(904)247-5845 RE412
Pi
03C
Job Address: `.2 - 1 �\ PPeerit Nu r
Legal Description �,�� - - O OcJ t 'ftAilil
(�'il��
Valuation of Work(Replacement Cost)$_ 17 1Ul Heated/Cooled SF olg h'77 a /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 detall the type of work to erformed:
� eY
Florida ProductApprovalw lcmp r mu tip a products use product approval form
Property Owner Worm -onz,�/ ` yf�
Name: Address'Jd U_ 1 1 r 1
city Stat ip Phone
E-Mail
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Informal
Name of Cyymp�y: V'Q uali g ent:
Address l-QLd r A State k- Zip
Office Phone lob Site/Conp«NumpperiF
State Certification/Registrationp E-Mail b,� )o C( T' Pr \ rl .r\
Architect Name&Phone p
Engineers Name&Phone p
Workers Compensation
Exempt/Insurer/lease Employees/Expiration can,
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
RECOR G YOUR NOTICE OF COMMENCEMENT.
(Signatures Owner or Age t n,(�rf ding Contr r) }$i 'ure of Contractor)
Signed and swornyto�(or affirmedjbeefyor�e me this_ ay of Signed and orn to(or affirmed)3f*
befo�r�e me this da of
—20—' by SFr col} LIS 30\4 r�l7.by _\t T1'Pi�/4fO—� G"O'' Jl�1
, � ( gnature of Notary) —� �tsignalue�of N . I
ly`" JEFFEIiY SCOTTREYNOLDS I ij�"' JEFFERY SCOTT REYNOLDS
nJ� MY COMMISSION*FF'SM!3 ! ) MYCOMMISSION#rFF180at3
y/TPersonally Known OR �. r1 . personally Known OR 5
[ I Protluced IdentiBratlo 3 r^"^ E%r n ^cher 3.2r ( I Produced Identification '� .° EXPIRES December 3,2010
Type of McMiRca[ion. loon xaa oa r Type of Identification: :4n1l1aamea F1_. �ygyy n