65 19th St DWAY23-0062 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
MATTINGLY PAUL G II 65 19TH ST ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
169723 1040 NORTH ATLANTIC
BEACH
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
65 19TH ST DRIVEWAY SINGLE OR TWO
FAMILY DRIVEWAY
Replace existing
concrete/paver driveway
with pavers
$13500.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 PUBLIC UTILITIES UNDERGROUND WATER SEWER UTILITIES INFORMATIONAL
Notes:
Avoid damage to underground water and sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is
needed, call 247-5878. State Law requires calling Sunshine 811 to have ALL public utilities located BEFORE beginning the work.
2 PUBLIC UTILITIES METER BOX SEWER CLEAN OUT INFORMATIONAL
Notes:
Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property
that may be found in the public records of this county, and there may be additional permits required from other
governmental entities such as water management districts, state agencies, or federal agencies.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
1 of 3Issued Date: 12/19/2023
PERMIT NUMBER
DWAY23-0062
ISSUED: 12/19/2023
EXPIRES: 6/16/2024
DRIVEWAY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
FEES
3 PUBLIC UTILITIES ADDITIONAL COMMENTS PUBLIC UTILITIES INFORMATIONAL
Notes:
See Revocable Encroachment Agreement regarding driveways/pavers and public utilities in the ROW
4 PUBLIC WORKS DRIVEWAY APRON INFORMATIONAL
Notes:
All concrete driveway aprons must be 5 inches thick, 4000 psi, with fibermesh from edge of pavement to the property line. Reinforcing rods or mesh are
not allowed in the City right-of-way.
5 PUBLIC WORKS EROSION CONTROL INSTALLATION INFORMATIONAL
Notes:
Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact the Inspection Line (904-247-
5814) to request an Erosion and Sediment Control Inspection prior to start of construction.
6 PUBLIC WORKS DUMPSTERS/ROLL-OFF CONTAINERS INFORMATIONAL
Notes:
Dumpsters and roll-off containers must be used in compliance with Section 16-8 and must comply with all standards, per City code.
7 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration, including sod, is required.
8 PUBLIC WORKS CONSTRUCTION SITE MANAGEMENT INFORMATIONAL
Notes:
Provide construction site management plan, including location of silt fence, dumpster, portable toilet. Right-of-Way Permit is required if using right-of-
way for construction parking.
9 PUBLIC WORKS MAXIMUM DRIVEWAY INFORMATIONAL
Notes:
Maximum driveway width within the City right-of-way is 20 feet.
10 PUBLIC WORKS GRASS INFORMATIONAL
Notes:
Full site to be grassed.
11 PUBLIC WORKS REVISION INFORMATIONAL
Notes:
Any plan change must be submitted as a Revision to the Building Department.
12 PUBLIC WORKS DEBRIS REMOVED INFORMATIONAL
Notes:
All construction debris must be removed from job site by Owner.
13 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Owner.
2 of 3Issued Date: 12/19/2023
PERMIT NUMBER
DWAY23-0062
ISSUED: 12/19/2023
EXPIRES: 6/16/2024
DRIVEWAY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PU REVIEW BUILDING MOD OR ROW 001-0000-329-1007 0 $25.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
ZONING REVIEW SINGLE AND TWO FAMILY USES 001-0000-329-1003 0 $100.00
TOTAL: $150.00
3 of 3Issued Date: 12/19/2023
PERMIT NUMBER
DWAY23-0062
ISSUED: 12/19/2023
EXPIRES: 6/16/2024
DRIVEWAY PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
Ys'--vi,, BUILDING PERMIT APPLICATION FOR INTERNAL OFFICE USEONLY
R
v
City of Atlantic Beach Building Department PERMIT# 1Jb iA`23--- U0L
0 800 Seminole Road, Atlantic Beach, FL 32233 ALL information required to process
ar phone: (904) 247-5826 Email: Building-DeptPcoab.us
Job Address t It4-k- ST o?RE# 4. 9 3 -/1990
Legal Description /7-g/ O ? -.q5 - (99C• `7 ' 0r '1 11/44h'6 gelte'1a/1i/ 34PE-.40047-Lora, ' OicThar
Valuation ofWork(Replacement Cost)4 13l o Heated/Cooled SF Non-Heated/Cooled SF
Class of Work: New El Addition NIAlteration Repair Move Demo Pool Window/Door
Use of existing/proposed structure(s): Commercial gResidential • Ifexisting structure, isa fire sprinkler system installed?:Yes1No
Will tree(s)be removed in association with proposed project? Yes (Must submit separate Tree Removal Permit) 1KNo
Describe indetail the type ofwork to be performed:
Rasp l sx,S-i-,) )C' / re-cc. -c9- pox>cr" w' '•-
rIac-/
e_
y5.
1
p 1J e v <, eS 7r S C4 are ke e.'
Florida Product Approval#For multiple products use Product Approval Information Sheet)
Property Owner Information Name Pa._,J,_IVA(4-4--1.-.1/V (`—_Phone '0(-1 1(3)- lq y
Address (c 5 /o1 4-4^- .. City 4 •State Fz.,_ Zip 2 3-- 3 3L
Email el,‘`[Nr‘,k ,(yMci1. Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contract, Information Name of Company Phone
Address City State Zip
Qualifying Agent State Certification/Registration#
Email Job Site Contact Number
Worker'sCompensation Insurer OR Exempt Expiration Date
Architect's Name Email Phone
Engineer's Name Email Phone
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation hascommencedpriortotheissuanceofapermitandthatallworkwillbeperformedtomeetthestandardsofallthelawsregulating
construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS, and AIR CONDITIONERS,etc.
NOTICE:In addition tothe requirements ofthis permit, there may be additional restrictions applicable to this property thatmay befound in
the public records of this city/county, and there may be additional permits required from other governmental entities such as watermanagementdistricts,state agencies, orfederal agencies.
OWNER'S AFFIDAVIT: I certifythat alltheforegoing information is accurateand thatall work will be done in compliance with all applicable
laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOU PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
MUST BE RECORDED AND POSTED ON THE SITE OF THE IMPROVEMENT BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BE ORE RECORDING YOUR NOTICE OF COMMENCEMENT.
A6<S), /Y._
Signature • • ne e Agent)
3 15+
Signature of Contractor)
Sind and sworn to(oraffir ed) before me this day of Signed and sworn to(or affirmed) before me this dayof
OC he' , 20 -23 by P it MG. Inc l by
Signature of Notary P97v7Q ea Signature of Notary
Personally Known OR [ Produced Identification a ed Identification
L PKI Vey, `iCZviSe DONNA L.BARTLE
Type of Identification: Type ,f• a ti, 3t yISS1ON#itFt985656_
11352 -6.8'7- CU S '_U 41-.g., EXPIRES:May 14,2025
Fo':'Fy?"• Bonded Thru NotaryPublic Underemters
ALL INFORMATION
rt'--%,,Owner Builder Affidavit HIGHLIGHTED IN
s
City ofAtlantic Beach Building Department GRAY IS REQUIRED.
o73 800 Seminole Rd, Atlantic Beach, FL 32233
fSVP Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: M 123—C(7IL'2_
I. FLORIDA STATUTES;CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES
OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7), FLORIDA STATUTES:
m z
STATE LAW REQUIRES CONSTRUCTIONTO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED
FOR A PERMIT UNDER AN EXEMPTION TOTHAT LAW. THE EXEMPTION ALLOWS YOU, AS THE OWNER
OF YOUR PROPERTY, TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A
LICENSE.
YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF.
YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY
ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000. 00 OR LESS.
THEBUILDING MUSTBE FOR YOUR USEAND OCCUPANCY. IT MAY NOT BE BUILTFOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE
CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH
IS IN VIOLATION OFTHIS EXEMPTION.
YOU MAY NOT HIREAN UNLICENSED PERSON ASYOUR CONTRACTOR. YOURCONSTRUCTION MUST
BE DONE ACCORDING TOTHE BUILDING CODES AND ZONING REGULATIONS.
IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES
REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT
SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. .
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDINGTAXAND/OR FORM 1099 REQUIREMENTS ON THEWORKERSTHEY EMPLOY ON THEIR IMPROVEMENTTRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYEDUNDERANY CIRCUMSTANCES.OWNERS BEING SUBJECTTO $5,000 PENALTY UNDER FLORIDA STATUTE NO.455-228(1). AN "OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THEOWNERSHOULDPHYSICALLYSEETHECOUNTY"CERTIFICATE OF COMPETENCY" OR THE FLORIDA"CONTRACTORS
CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSEDCONTRACTOR. CONTACTTHE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPT@COAB.US ) IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
ob Address: (05 /1
M L Phone Number: 49 1canerName: -, / r t "
C l i State: — Zip, 2L3 3MailingAddress: 6,5 lc, J ' City: ` ,
Notarized Signature ofe /vNotagOwner
fhe foregoing instrument was acknowledged before me this day of OCIV her , 20 23, in the State of Florida, County
Of Duval
G 2SignatureofNotaryPublic04-tA'1_et
D0
my
BARTLE
t.1YC04MISSION#HH085656 [ ] Personally Known OR [ Produced Identification
EXPIRES:May 14,2025 jBondedThruNotaryPublicUnderwritersTypeofIdentification: L Driver ,/'`^ 05 3—a
Updated 10/24/ 18
NOTICE OF COMMENCEMENT
State of Tax Folio No. /l 9 723'/0i/o
County of 1)
ToWhom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713
of the Florida Statutes,thefollowing information is stated in this NOTICE OFCOMMENCEMENT.
Legal Description of property being improved: LI 1 -1 I 01'- 2 S -2_9 E - i ( y
COMMENCEMENT. .4 t k___
eQ_,c_eN w 3 p C io FT LWI— 3 tJ H 0 FT Lc LI
Address ofproperty being improved: 6, S j 1' S
General description ofimprovements: Re t e - L Y` s 4---,:: Co^ sce 4'f'
Vc.../.2_7c f `Ve w ct 4-L_ v \fC(-5r
Owner: ...v... ek`"`F`i Address: CO 5 (9-4" S 4--
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
moco
o x
Contractor: k,Wiei 72 DA V(-4 ll&eS
c000c
o
6s- /q 3 Pi 2a a3 2 ro2Address: Q j G' v;0i c
vo-6 (6) Fax No: IIo
0 _rnTelephoneNo.: rgrnN 0
Surety(ifany) m m
Address: Amount of Bond$ 04, xcc
Telephone No: Fax No: c
Name and address ofany person making a loan for the construction ofthe improvements o 2
Name: 0.,-v\ r° 4 4-1 5`` o
Address: (,I +
91 5'
D
Phone No: Cie`I -1 S o 9 1 5 Fax No:
r
Name ofperson within the StateofFlorida,otherthan himself,designated by ownerupon whom notices or other docum
be served:Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date ofNotice of Commencement(the expiration date is one (1)year from the date ofrecording unless a different date is
specified):
7-4,4-.iTHISSPACEFORRECORDER'SUSE ONLY OWNER
J
Signed: Q1t/YL6( •//
y3")------
C-
THIS
Date: I 3I/ZQZ.3
Before me this 31S-1- day of OC fit' 2023 1 the Coy nty ofDuval,lllState
Of Florida,has personally appeared ( ( M(4 h5/(wDONNA BARTLE Notary Public at Large,State of Florida County of Duval. Jr}t ° :
OOMMISSIONN HH 085656 My commission expires: / ZD ZSn. `
orEXPIRES:Ma 14,2025EOff`t`• Y Personally Known:Bonded NuNotary PublicUnderwkers Produced Identification: FL til ver L JCe I se
435Z .- 6t7-61, - 053 -0
MAP SHOWING BOUNDARY SURVEY OF
THE EAST 10 FEET OF LOT 3, AND THE WEST 40 FEET OF LOT 4
A REPLAT OF TRACT A P(ORTH ATLAN1T1 C BEACH UNIT
ACCORDING TO THE PLAT THEREOF RECORDED IN PLAT BOOK 47, PAGES 91 AND 91A,
CERTIFIED TO: OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
PAUL G. MATTINGLY, II AND LYNN M. MATTINGLY, HOME POINT FINANCIAL CORPORATION,
FIRST AMERICAN TITLE INSURANCE COMPANY AND GIBRALTAR TITLE SERVICES, LLC
TRACT I"3"
SEMINOLE DUNES
O.R.B. 5793, PAGE 776
1/2- N 89'45'52" E 50.00' (C) 5/8. 1/2"IRONPIPE
REBAR N 89'48' 46- E 50.00' (M) PSM 4690 (CHR)
0.8'
X
r°.i' ,0, SUBDIVISION BOUNDARY 0, 8•-.1
x
y0.1' 0.47' E'LYf
fir'-
IH0T 00' ).._-L7—64 20.00' (R)50.00' (R) ON UNE 10.00' (R)I TUB x-1.5'WALL)
II
PAVER STEPS 0
RETAINER ID-........1.
IWALL W000= 7-1 1, ROCK0DECK— _
0.2' 10: '
WA)..0 24.0' D
WOOD llSNOWER I 21_ n STEPS 'ter CC
0.6-1 ;,...?.6'..._ ,' r.`` ' 7.6b..
5.4• 2-STORY 5.3•o ip STUCCO PAVER I)vo
000.1 -.1 NO. 65 WALK I o
00 0.6'- o 0 o 20.1'
l
o` 012.2'
a0
O 1 o r =
WWEST50' 3 w 0- m SECOND STORY t
OF LOT 3 to 9. CONC 7,3COVD ' OVER CAR PORT Nw
w BLOCK \ ND3CO
CD m 7.7... /\1 'ALLS 7.6'.. o O7.3'
UPPER WOOD 7 o .,g ROCK E DECK OVER tO
CAR PORTz
CONC Qa 5 bOPAVERSO
I
O 1.8•
PAVER
o
NZ
4inWEST0' DRIVE
oF-m OF LOT 4 M AST 20'
I--fOF LOT 4
w0 V-I CONC
WATERLINE EASEMENT DRIVE
AS PER O.R.B. 5372. PAGE 831 i._4R
144rrt9' ti
n 50.00' (R) 10.00' (R)1 40.00' (R)
OU—OU—OU—OU— U-- OU OU—OU • OU
1/2 GE OF PAVEMENT 5/8• N 89'41'07' W 193.25' (M) N& D
IRON PIPE REBAR N 89'45'52' W 193.20' (C)
LS 3848 BEARING REFERENCE PSM 4690
S 89'45'52' W 49. 89' (M)
S 89' 45'52" W 50.00' (C)
19TH STREET
40' R/W)
FLOCO ZONE-X" - AREAS DETERMINED TO BE OUTSIDE THE 0.2%ANNUAL CHANCE FLOOD PLAIN / FLOOD ZONE "X(SHADED)" - AREAS CF 0. 2%ANNUAL CHANCE FLOOD: AREAS OF 1%ANNUALCHANCENMAVERAGEDEPTHSOFIFASTHAN1FOOTORWINDRAINAGEAREASLESSTHAN1SQUAREMILE: AND AREAS PROTECTED BYLEWES FROM 1%ANNUAL CHANCE FLOOD.
v E Y 0 GENERAL NOTES:
ca, 1. BEPRINGS ARE BASED ON PLAT BOOK 47, PAGE 91A.J s 2. STRUCTURE NO. 55 SHOWN HEREON UES WHIN FLOC() ZONES BEST DETERMINED
CO FROM F.E.M.A. FL000 MAPS PANEL N0.407 DATED 06-03-2013
ASSOCIATED SURVEYORS INC 3. THIS ISA SURFACE SURVEY ONLY. THE EXTENT OFUNDERGROUND FOOTINGS, PIPES ANDU1?J1ES, IF ANY, NOT OETrJW'NEO.4. JURISDICTIONAL AND/OR ENVIRONMENTALLY SENSITIVE AREAS IF ANY, NOT LOCATED BY THIS SJRVI
I LAND A ENGINEERING SURVEYS 5. THIS SURVEYfBASED ON LEGAL DESCRIPTIONS FURNISHED.BLIRNISHED. THE PUC RECORDS WERE
I INFORMATION
e.„,„ Revision Request/Correction to Comments HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
sig'
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: t.)wlQ kr-23 " -2--
Revision to Issued Permit OR Corrections to Comments Date: / b,512-u2-
Project Address: (Q 5 / 9 -i-k__. L)4--
Contractor/Contact Name: -PC v 1 l r/),..,-\ +,„, g `''
L t{ p
J u
t
Contact Phone: ( ) t t-1 O ei Email: pet_a. 1 j r1(\ fyi 0.- Mu,)0 C c
1
Description of Proposed Revision/Corrections:
Pte.t.'u
7., '..-
1 l b _ eg )(\, p ic c.t EC-'
e 3,3 4- e a . cam,, S dpMVO v c w ,) I At) 4.---
e > c e
en Cr-
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T
c ru c,,_s af''e_c.<5 . Co e r_z^
i y be, 4'Ae_ Sc-71-e_ IeSs .
t_,,.\ M A.V,n)k - affirm the revision/correction to comments is inclusive of the proposed changes.
Printed name) 0
Will proposed revision/corrections add additional square footage to original submittal?
NNo E Yes (additional s.f. to be added:
Will proposed revision/corrections add additional increase in building value to original submittal?
No E*Yes (additional increase in building value: $ contractor must sign if increase in valuation)
Signature of Contractor/Agent: `y_.-- 2
l
Office Use Only)
C Approved f_I Denied H 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
By vangers at 1:11 pm, Dec 15, 2023
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $150.00
DWAY23-0062 Address: 65 19TH ST APN: 169723 1040 $150.00
PUBLIC UTILITIES PLAN REVIEW $25.00
PU REVIEW BUILDING MOD OR ROW 001-0000-329-1007 0 $25.00
PUBLIC WORKS PLAN REVIEW $25.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
ZONING PLAN REVIEW $100.00
ZONING REVIEW SINGLE AND TWO FAMILY
USES 001-0000-329-1003 0 $100.00
TOTAL FEES PAID BY RECEIPT: R25802 $150.00
Printed: Tuesday, December 19, 2023 11:44 AM
Date Paid: Tuesday, December 19, 2023
Paid By: MATTINGLY PAUL G II
Pay Method: CREDIT CARD 10123227511
1 of 1
Cashier: TG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R25802