340 2nd ST RES21-0371 Revision form 1-3-21_1RES21-0371
Revision Request/Correction to Comments
City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
**ALL INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: _______ _
G Revision to Issued Permit OR D Corrections to Comments Date: , \ ;> \ '"UYl-1-, \'
Project Address: 3'fo ? &-(µ.€[
Contractor/Contact Name: S;5a .... +►\'C.. \~oottJ ~ De,\A?,.lcff1'\e.,-.,+,ykl. &-f 11 ): / /,'~ 1o<-1) ?J?;-1',?
Contact Phone~o<-01~'t:f-G(S<,1 Email: f'"G!f-:@Si3'now-c,.s{/. con--:,,
Description of Proposed Revision/ Corrections:
l-1~i,-.;'l.,..JL=--:S:~· __..LU""'"-·_, .._I _._l~-'-fl~~-.c='----affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• Will propo~i:>r1 revision/corrections add additional square footage to original submittal?
l:i:21No ~ .. .all Yes (additional s.f. to be added: ____________ )
•~illyrop~d revision(~orrec~ions ad~ add'.ti~nal increase in building value to original submittal?
l.l.,J1CJo ~*Yes (add1t1onal increase in bu1ldtn Yal : .,_,_ _______ ) (Contractor must sign if increase in valuation)
(Office Use Only)
D Approved D Denied D Not Applicable to Department Permit Fee Due$ _____ _
Revision/Plan Review Comments -----------------------------
Department Review Required:
Building
Planning & Zoning
Tree Administrator
Public Works
Public Utilities
Public Safety
Fire Services
Reviewed By
Date
Updated 10/17/18
RES21-0371
TREE & VEGETATION AFFIDAVIT
City of Atlantic Beach
Community Development Department
800 Seminole Road Atlantic Beach, FL 32233
(P) 904-247-5800
SITE INFORMATION
ADDRESS
RE# lb9"1lt>S-oooo
APPLICANT INFORMATION
NAME -uc:u.i, ct B O..Od Y"lCix::C-D -::r t).)o..d..L
ADDRESS r'\ S \ o E:JX:::) a,_y c.f1 JF Vb\) ~
FOR INTERNAL OFFICE USE ONLY
PERMIT# ______ _
LOT 16
~ RESIDENTIAL 0 COMMERCIAL 0 OTHER
PHONE#
CITY Ro 'O c.p-e..,. STATE \ LL ZIP CODE lo\ D7 ~ ---~------
EMAIL K,.1.::i ode '3 k-o'o @ ~roQJ...\:. C.Ora ~ OWNER 0 LEGAL AUTHORIZED AGENT
I affirm that I have reviewed the provisions of Chapter 23, "Protection of Trees and Native Vegetation", of
the Municipal Code of Ordinances for the City of Atlantic Beach Florida and/or I have participated in a pre-
application meeting with the Administrator of those regulations. Subsequently, I affirm that no regulated
trees and no regulated vegetation will be damaged, destroyed and/or removed from the above-described
property and/or adjacent properties including right-of-way.
I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT: Signature of Property 0wner(s) or Authorized Agent
~~6 vJo--g :K OtI ~"' 3 vfu <2--,z/, .;Jj 2 I
SIGNTUREOFAPICANT PRINT OR TYPE NAME DAE
SIGNATURE OF APPLICANT (2) PRINT OR TYPE NAME
Signed and sworn before me on this _Oc.....-_day of 5e~e...cobe.v-I '.'.1.a;)...\ by
DATE
State of "\='.\~c\,n.....
County ofr-p_ll)()L
Identification verified: PeX":';;2.Q'f\Q..U...1..\ \'..£p\l)f\ I
Notary Signature
My Commission expires I' I ?-'a j 202--2-
04 TREE AND VEGETATIONAFFIDAV/T03.0J.2018