447 ATLANTIC BLVD SUITE 4 CHNG25-0001 ‘0A'441' CHANGE OF USE-OCCUPANCY APPLICATION FOR INTERNAL OFFICE USE ONLY
1r City of Atlantic Beach Building Department PERMIT# C HN - "(��01**ALL information required to process
T5-air- 800 Seminole Road, Atlantic Beach, FL 32233
`,: Phone: (904) 247-5826 Email: Building-Dept@coab.us
$200.00 Application Fee
J Change of Use-Occupany where no work is required ❑ Change of Use-Occupany where work is required
BUSINESS/APPLICANT INFORMATION (this will require a building permit)
Business Name Tau .Acl v iSSo r i 6 rou(r 06 J ac_k_so r-,v I ( Le �� OC....
Applicant Name TCLvv e3 K . ,,C se Applicant Title 'res8j' -'
Mailing Address Yips 4 y Ac;,,,1( c ..4g4 Or Applicant Email .\ ; (? @ .. avy-leS K re eseect
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City TOC--ICS() elV it_ate lPLZip 3zZ7 S Applicant Phone 91)4 - -57 2_ -c)--2-4-4
ADDRESS OF BUILDING OR STRUCTURE
Street Number and Name 44-1 J\-Han-4-i c, "Blvd � SU►tQ. 4 ) A+\CUlt1 c13Ce-C n
.1233
Nature of Business(proposed use) -BOO ICk.c)i) el rvi .6/i (f2_,D : Fax_ ?rp .c t 4i( 3
PROPERTY OWNER INFORMATION
Owner of Record St r)a a✓i Lyo' e-- a( Property Owner Info can be obtained from the
Li f
Mailing Address `l1 IA+Iairtic E Ivo\ suite, Duval County Property Appraiser's website
City HAOLVAI G LIC31'{ate Ft Zip 33;7Z3 Owner Phone (10`7 ` 613• q /s-
Parcel ID Number(s) 110 Hi_ U 50 0 Owner Email J` r I yO0 13 4 J o J ivuu.l i«wm
• Planning and Zoning must confirm that your new proposed change for the building or space is approve for the type of business use.
• A request for Change of Occupancy or Use must be submitted along with design drawings showing the current life safety plan.This
initial application may eventually require additional permits to make modifications to the building or space in order to comply with
current codes.
• Upon receipt of a sufficient application and payment of required field safety evaluation inspections($200.00),the Building Official and
possibly the Fire Marshal will conduct a field safety evaluation of the subject property.
• If the field safety evaluation reveals deficiencies or code violations,they must be corrected before a new Certificate of Occupancy or
Use will be issued.
• Any remodeling or renovations require separate permit application(s). All signs require a building permit.
• Trade permits may be required to be obtained by qualified licensed contractors to bring mechanical,electrical and/or plumbing
systems up to code.
• A Change of Occupancy or Use may result in handicapped accessibility requirements related to entrances,accessible route to altered
areas,at least one accessible rest room,accessible telephones and drinking fountains,and when possible,accessible parking.
• All violations/corrections shall be corrected prior to re-inspection AND/OR prior to issuance of Certificate of Occupancy or Use.
• A business tax receipt is required prior to opening. Business Tax Receipt
"In lieu of s': ed,s. o and notarized signatures of the property owner, agent and/or contractor,and under penalties of
perjury, (declare th. - have rea• . • examined the foregoing application and that the facts stated in it are true and correct."
/ TOM-es K.Pe -e- 1 /1.-11-07-S
SIGNATURE O• • '• rop PRINT OR TYPE NAME OF APPLICANT DATE
Change of Use-Icy Application 12.10.2024