340 2nd St (vault) RECEIVED
CITY OF ATLANTIC BEACH NOV 2 4 1997
ROOFING PERMIT APPLICATION City of Atlantic Beach
Building and Zoning
JOB LOCATION: -� � `
OWNER OF PROPERTY: i a
CONTRACTOR:
CONTRACTOR'S ADDRESS: �J �f' / ��'f��j✓ /a/
ZIP:
STATE LICENSE NUMBER: CC / �f� TELEPHONE: - /S��
DESCRIBE WORK TO BE PERFORMED:
OP
VALUATION OF PROPOSED CONSTRUCTION
MATERIALS TO BE USED:
SIGNATURE OF OWNER:
SIGNATURE OF CONTRACTOR:
SWORN TO AND SUBSCRIBED BEFORE ME THIS `{ DAY OF 6 )OU �g
9
NOTARY PUBLIC
Liability Insurance Supplied
Workers Compensation Insurance Supplied
Contractor License Information Supplied
Occupational License Information Supplied
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PSR -3844 1 605
DEPARTMENT OF BUILDING
CITY OF ATLANTIC BEACH
PER.MIT INFORMATION LOCATION INFORMATION
fermi Number: 15605 Address: 340 SECOND STREET
Per nit Type :RE --ROOF ATLANTIC BEACH, FLORIDA 322-
"lass of Wark:lE __.__,____ LEG
DESCRIPTION _..__.
Cons r. Type:WOOD FRAME B Lot: TwL
Prop sed Use: Section: 0 Subd :O Rnc
D ellings: 1 Subdivision :ATLANTIC BEACH
Es.. Val ue: 0,00
Impr v . Cost: 5,500.00
T4 atl Fees- 25.00
R I P`C) 3 AT I O N APPL I CA I N r Er
Name. R' +t PERMIT 25,
Adder , �y. p t tt�� , C�. ON D- STREET
11 RKA TV.! B A.C.H" FLOE T P:t 37'7',
P (§0 4 ` 1 - 24 7 -- 6622
- ----- CONTRACTOR T NFOrRMAT I u , _
Name: JACK C. € I LSON RO OF I NO C+OM.PAN Ii
4522 ST.AUOUSTINE RD.
_
JACKSONVILLE. FL 32207
Lic: CCC049358 Exp:
NOTES:
NOTICE - INSPECTIONS MUST BE REQUESTED AT LEAST 24 HOURS PRIOR TO INSPECTION
BUILDING MATERIAL, RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE, AND MUST BE
CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER
"FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN
THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS."
ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR
VIOLATION OF APPLICABLE PROVISIONS OF LAW.
ATLANTIC BEACH BUILDING DEPART ENT
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