2021 VELA NORTE CIR RESO23-0004 REVISION 1-27-23 prosRevision Request/Correction to Comments "`ALL INFORMATION
HIGHLIGHTED IN
`� City of Atlantic Beach Building Department GRAY IS REQUIRED.
ker 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: ESO on- OOOy
❑ Revision to Issued Permit OR N Corrections to Comments Date: 1 /. .1 /2'-02"3
Project Address: oZ O;1 \ U ei n_ J\t o rte Cir .
Contractor/Contact Name: [c�.e'(i, 1,Jpdi,s / /`'la-ni 0 Mtft'sSQ
Contact Phone: 10UJ' 99 to - 07102 Email: S CL55+1 e � 1- o(ks opv\cti��. co ws
r�
l (Me./issa)
Description of Proposed Revision/Corrections:
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0 gee Ver-4_4o4 443,'doLv4 kQ5 now 1:ceyl coktyl ci (AA) irce_S 4,Le_reMava) .
1 S-i- k. t 1-1-€44 e I affirm the revision/correction to comments is inclusive of the proposed changes.
( rinted name)
• Will proposed revision/corrections add additional square footage to original submittal?
Ilii No ❑ Yes (additional s.f.to be added: )
• Will proposed revision/corrections add additional increase in building value to original submittal?
IgNo ❑*yes (additional increase in building value: $ )(Contractor must sign if increase in valuation)
*Signature of Contractor/Agent:
(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
:0-Aii‘iric, TREE & VEGETATION AFFIDAVIT FOR INTERNAL OFFICE USE ONLY
1' City of Atlantic Beach
i'' PERMIT#
�� Community Development Department
800 Seminole Road Atlantic Beach,FL 32233
`4 mi (P)904-247-5800
SITE INFORMATION
ADDRESS ,72 O 7 ( V e (Q Ito(le Cr_ 14-J/a tk- I..?ear4 /« 3 a a 3 3
SUBDIVISION S Cilia- dOriZ J01BLOCK Oplif- DNC LOT S-3
RE# S D.23 — OOO / g.RESIDENTIAL ❑ COMMERCIAL ❑ OTHER
APPLICANT INFORMATION 1 r
NAME 54,10 1,R, e,(-1'21 PHONE# y/3 -y5y_ dos-?
ADDRESS 0 t V GI a_ No rk. (.',r , CELL#
CITY —40-,,--1i c_ lj c L STATE �L ZIP CODE 3-� 3 3
EMAIL 5 K her 1-d Q l M . ( , C011( (l OWNER ❑ 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:rSiignature/of Property Owner(s)or Authorized Agent
fLI TS O� 1 f'MeI/ --
IA'URE
OF A LICANT PRINT OII TYPE NAME DA
SIGNATURE OF APPLICANT(2) PRINT OR TYPE NAME DATE
Signed and sworn before me on this Z 7 day of --3Q I� , ZOZy State of r
county of LoVOL., `
i
Identification verified: T-
Oath Sworn: ❑ Yes ❑ No
�FnV phi•,
Notary Signature
::: TONIGINDLESPERGER
,ii „ MY COMMISSION#GG 353178
` My Commission expires' EXPIRES:October6u2023 f _
( Foe F`o
_ ".,,,„ Bonded Thru Notary Public Underwriters
04 TREE AND VEGETATION AFS• ' • 7.-7 •--