78 W 9th St re-roof permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
r2l 9' INSPECTION PHONE LINE 247-5814
REROOF SHINGLE -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RERF17-0198
Description: SHINGLE ROOF
Estimated Value: 8750
Issue Date: 12/5/2017
Expiration Date: 6/3/2018
PROPERTY ADDRESS:
Address: 78 W 9TH ST
RE Number: 1708139500
PROPERTY OWNER:
Name: MYLIUS LUCIA SO
Address: 78 W 9TH ST
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name:
Address:
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$7,500.
Building Permit Application
P City of Atlantic Beach
800 Seminole Road,Atlantic Beach, FL 32233
Phone: (904) 247-5826 Fax: (904) 247-5845
Job Address: 51r�, t 4�1a,,A i- &" 72'23) Permit Number:
Legal Description 46-3,/ /7-Z ;C . tqe-� RE#
Valuation of Work(Replacement Cost)$ Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition AlteratiorI(:Re:p�l5rMove Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial 0��
• If an existing structure, is a fire sprinkler system installed?(Circle one): Yes N o (�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:
Florida Product Approval# FP 10 17-11 4- 4��i 66 Z.& for multiple products use product approval form
Property Owner Information
Narne: /" YLI a S Lot 6t A Address: 70
city Ke r-cil —State 41 zip 3 2-2-3? Phone PW- 5401? - .7(10(13
E-Mail 114e_4,aMq1i&S
Owner or Agent(If Age'nt, Power of"Attorney or Agency Letter Required)
Contractor Information
Name of Company: -t '417,-- Qualifyin Age Jry 4"'.
Address 2-3 &�� 1=4A_f_ A 9 - -1 F-_ �, rlap�44, State XL- Zip-?2-Vel
Office Phone (0'7 9-JJjF3 — Job Site/Contact Number
State Certif ication/Regist ration# CX-CI3310S�5_ E-Mail jar,c, f .10ep,&A-
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation
Exempt/Insurer/Lease Employees/Expiration 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 OBT IN FI ING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECO �CE OF COMMENCEMENT.
t e wher or Agent including Contractor) (Signature of Contractor)
"X�Y
Sig orn to(or affirmed)before me this i I day of ��ignecl and sworn to(or affirmed)before me this III day of
by LRr�/7V4YLJ-_zL W015��, Z1914- by
AffleWWA("Awry)
ARICi ...
COMMISSION#66121293 NOTARY COMMISSION 0 GG121293
EXPIRES Jullv 04,2021 PUBLIC
11110NOID T"NOUGH STATE OF EXPIRES JUN 04,2021
lion Person Ily AU"OURANCI COWANY KPers mal OR IOMXO THROUGH
Ile RU WGURAW COMPANY
[ ]Pro 4_1 -4r:
Type of Identification: Type of Identification:
NOTICE OF COMMENCEMENT
State of Tax Folio No.
County of ONAUA-L-
To Whom It May Concern:
The undersigned hereby infornis 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.
Legal Description of property being improved: Zj? -31/ 17-aS—.2?*0,0465?
Address of property being improved: -7 &4!n�A�
r
General description of improvements:
re
Owner: /—I&C4 9 Address: 79 4/, 9,61 k,;-
Owner's interest in site of the improvement: Av"
Fee Simple Titleholder(if other than owner):
Name:
Contractor: I Av,&,o /-,t C -
4��ddress: 13 t044y.44yzr
TelephoneNo.: 90K Fax No:
Surety(if any)
Address: Amount of Bond$
Telephone 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:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is (1)year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
'R
Signed: Date: I ILL
Before me jti —day of Mqjr!%!�t in the Counfy uval,State
Of Florida, personally appeared 4IM50( WjA%;e 3
Doc#2017276066,OR BK 18_�'m Page 269, otary Public at Large,State of Florida,County of Duval.
Number pages:I ly commission expires: T�q_zt -
Recorded 12JO412017 11:28 AM, ersonally Known: 494 or
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
COUNTY roduce( I-:PH-6AN
93
RECORDING $10.00 ARIC JOSEPH RYAN
PMIC COMMISSION 0 GG122293
t 0 1
------- SYATE OF EXPIRES July 04,2021
nFLONVA AONXD Tmaoww
Cash Register Receipt Receipt Number
City of Atlantic Beach R3792
DESCRIPTION ACCOUNT CITY PAID
Pe.,mitTRAK $55.00
RERF17-0198 Address: 78 W 91'. 170813 9500 $55.00
ROOF FINAL 12/14/2017 MJ $55.00
ROOF FINAL 12/14/20'.7 45500003221002 0 $55.00
TOTAL FEES PAID BY RECEIPT: R3792 $55.00
Date Paid: Friday, December 29, 2017
Paid By: MYLIUS LUCIA SO
Cashier: LE
Pay Method: CREDIT CARD I
Printed: Friday, December 29,2017 8:52 AM 1 of 1 Of