325 ROYAL PALM DR ACC22-0002 revision 2-16-22 Revision Request/Correction to Comments **ALL INFORMATION
HIGHLIGHTED IN
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a 0 City of Atlantic Beach Building Department GRAY IS REQUIRED.
a 800 Seminole Rd, Atlantic Beach, FL 32233
�'� Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: -( L - L Z.
❑ Revision to Issued Permit OR I I Corrections to Comments Date:
Project Address: �V c'k T�-'-'L'•`'S
Contractor/Contact Name: AR-75"v
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Contact Phone: `'7U� 1 c�- Email: �� (SA)
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Description of Proposed Revision/Corrections:
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affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• Will proposed revision/corrections add additional square footage to original submittal?
ekiNo ❑ Yes (additional s.f.to be added:
• ill proposed revision/corrections add additional increase in building value to original submittal?
51 . ❑*yes (additional increase in building•tt$ ) (Contractor must sign if increase in valuation)
*Signature of Contractor/Agent: #A1 ---
(Office
(Office Use Only)
❑ Approved ❑ Denied ❑ Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comments
Department Review Required:
Building
Planning&Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services Updated 10/17/18
4 1-.Aib r, TREE & VEGETATION AFFIDAVIT FOR INTERNAL OFFICE USE ONLY
C) '% City of Atlantic Beach
r w Community Development Department PERMIT#
800 Seminole Road Atlantic Beach,FL 32233
d'1..0i3 9 (P)904-247-5800
SITE INFORMATION
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ADDRESS ' s J 1
SUBDIVISION 03 ,a� RayKS V Oaick BLOCK ILA LOT ) l
RE# n 173 " \ —OOc)? tielESIDENTIAL ❑ COMMERCIAL ❑ OTHER
APPLICANT INFORMATION
NAME PHONE#9,4,..)3(4636 v
ADDRESS .3&S--- ,.,7jC-- c JJ CELL#
CITYP--4A.00/- ^ STATE ZIP CODE &C)N4CDr- 3
EMAIL - d EL ` S iWNER ❑ 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 Owner(s)or Authorized Agent
-idiom' - '�. , Lipa a
SIGNATU'' : • ICANT PRINT OR TYPE NAME DA
SIGNATURE OF APPLICANT(2) PRINT OR TYPE NAME DATE
Signed and sworn before me on this i I day of ----6._...----6._...0 :z02? /o2? by State of r `
County of v1/'c_
Identification verified: (Th , Oi
Oath Sworn: ❑ TONI GINDLESPERGER57 FUQ .-- _
',Q MY COMMISSION It GG 353178 Notary Signature
.;4;- �'o` EXPIRES:October 6,2023
•''`..Rp(Niw Bonded Thru Notary Public Underwriters My Commission expires
04 TREE AND VEGETATION AFFIDAVIT 03.01.2018
MAP SHOWING BOUNDARY SURVEY OF
LOT 11 BLOCK 14 ACCORDING TO THE PLAT OF
ROYAL PALMS UNIT TWO A
AS RECORDED IN PLAT BOOK 31 . PAGE(S) 1,1 A,18.1 C AND 10 OF THE CURRENT
PUBUC RECORDS OF DUVAL COUNTY. FLORIDA.
CERTIFIED TO:
CYNTHIA GILBERT,
CIRRAT.TAR TITLE SERVICES.
AND OLD REPUBLIC NATIONAL TITLE INSURANCE COMPANY.
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904-77t-6468 RECOROS stall NOT SEARCHED BY THIS suRvFYOR TOR EAsEmENTS, TITLE.
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