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Permit 190 16th StreetCITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5826 Application Number 09-00002020 Date 12/22/09 Property Address 190 16TH ST Application type description RESIDENTIAL ADDITION/ALTERATION Property Zoning TO BE UPDATED Application valuation 7000 ---------------------------------------------------------------------------- Application desc close in porch add window ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ BOLE OWNER 190 16TH STREET ATLANTIC-BEACH FL 32233 --------------------- Structure Information 000 000 ---------------------- Construction Type TYPE 5-A Occupancy Type RESIDENTIAL Flood Zone ZONE X ---------------------------------------------------------------------------- Permit BUILDING PERMIT Additional desc . Permit Fee 85.00 Plan Check Fee 42.50 Issue Date Valuation 7000 Expiration Date 6/20/10 ---------------------------------------------------------------------------- Special Notes and Comments *2007 FLORIDA BUILDING CODE W/'05-'06 SUPPLEMENTS. 2007 FLORIDA BUILDING CODE - RESIDENTIAL. 2005 NATIONAL ELECTRICAL CODE. WINDOW AND DOOR INSPECTION: *INSTALLATION INSTUCTIONS REQUIRED *ALL STICKERS ARE TO REMAIN ON THE WINDOWS *PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 85.00 85.00 .00 .00 Plan Check Total 42.50 42.50 .00 .00 Grand Total 127.50 127.50 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. _. _ - a-nr of aTLANTlc BEacH 09 _ ~ ~ ! ~ ~ :~ ~ ~ ~ !'~~~ 600 SEMINOLE ROAD. ATLANTIC BEACH, FL 32233 -r OFFICE: (9D4)247-5826 ~ FAX NO.:(904~47-5845 ,! BUILDING-DEPT~COAB.US _-_ ~ ~' BUILQING PERMIT APPLICATfQN n! lent rnt tntrv ;; 1. JOB Apf]RES9: - ------- 2 ALUATTON OF WORK' 3: 50: FT. UNDER ROOF l O I(~f`I SZaEET 7avo,o`' =4: LEGAL-DESORIPTION;.` 5:CLASS OF WORK-' fiYUSE OFBTRUCTURE LOT ~~ ~ ~~~ ( ^ V ~3 O ^ NEW BUILDING ^ DEMOLITION ESIDENTIAL ,/ BL CK SUB DIVISION - ^ ADDITION ^ CONVERTING USE ^ COMMERCIAL 7:`DESCRIPTiON OF WORK: (~ALTERATIDN ^ ACCESSORY BLDG. 8. FIRE SPRIN ^ REPAIR ^ POOL/SPA ^ YES NIA ^ MOVE ^ OTHER ^ NO PROPERTY OINMER: CONTRACTOR: AR€HITEC Tr ENGINEER: " 9. NAME: ~a-ru~ 8ot,~ 15. COMPANY NAME: 3. COMPANY NAME: c5 N S ~r t6. NAME: 24. EN EE NAME ^^ ww '' '' 1.~ 10. ADDRESS: ~ cj ~ 1(p'~'1'f 5'j'~;,~' 17. STATE OF FLORIDA LICENSE NO.: 25. STATE OF FLORIDA LICENSE NO.: G C LXo 02 7 3 18. ADDRESS: 26. AD"DuR~ESS: .~yy~~ ~ ~r ~~I'f ~i~~~~ •Y~~ 11. OFFICE PHONE: 12. FAX NO.: 19. OFFICE PHONE: 2d. FAX NO. 27. OFFICE PHONE 28. FAX NO.: 13. CELL PHONE 21. CELL PHONE: 29. CELLPHONE 14. EMAIL ADDRESS: 22. EMAIL ADDRESS: 30.~~ILC Q SS•.C~~s~, ~ ~ ~~ . d FEE SIMPLE TiTLEfHOLDER: (IF OTHER THAN OWNER) BONDING COMPANY: MORTGAGE LENDER: ' - 31. NAME: 33. NAME 35. NAME: 32. ADDRESS: 34. ADDRESS: 36. ADDRESS: Appliption is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of al! laws regulating construction !n this jurisdiction. This permit becomes null and void if work is not commenced within six (6) months, or if construction or work is suspended or abandoned for a period of six (6) months at any time after work is commenced. 1 understand that separate permits must be secured for Electrical Work, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters, Tanks, Air Conditioners, etc. OWNER'S AFFIDAVIT - I certify #hat all the foregoing information is accurate and that. al! work will be lane in compliance with all applicable laws regulafing construction and zoning. 1 will not occupy or use the referenced building or any part therof, until all inspections are finaled and prior to obtaining a certificate of occupancy or completion issued by the building offiaal, as required by law. ~ 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 ~3EfORE TI.1~~,~x - FIRSTINSPECTION. IFYOU INTEND TO OBTAIN FINANCING CONSULT WITH YOUR . LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. OWNER or AGENT COPdTRACTOR (If Agao~ Pourer ar Attorney enry Letter Required) (Qualifier Only) Signed`. r ~ Date: (~ ` (~ ` ~~ ~ Signed: Date: / n B f thi ~ ~~~ 1 e ore me s _ day of _1 V , 2009 in the county of Before me this day of , 2009 in the county of Duval, State of Florida, has personally appeared Duval, State of Florida, has personally appeared 1 C1:'FNe i ~ fl'L 3C~ herin by himself /herself and affirms that all statements and dec{aratons are herin by himself /herself and affirms that all statements and declarations are true and accurate. true and accurate. ~`"_ Notary Public at Large, State of ~ County of . - ~ Yl Notary Public at Large, State of ,County of ^ Personally t(nown Y i l ~ ^ Personally ICnowrt Q Pmduced Identificati~ n - ~ 1 r.- ^ Produced Identficatfon - NotarySignature: ~ ~ . __ Notary Signature: .u+KW.NYbcWPa_tiiA+`.th~:'+Xfyle+-'S~.Y%~.'YItlILfI IYA"1M..sM a, r1 ~ ~~ ~ BLDG01 Permit Applicetiort Bldg: R ~ ICED: FILE COPS rt+w~ss~n+•w.sRn..er.sr wa~s.+s~rea M ~~ r.,:..~~•.~~, rvx wli~: I;UMPLIANCE _ ~ CITY OF ATLANTIC BEACH ~,a" REBcCCA MENDEZ SEE PERMITS FOR ADDITIONAL O,~FµV PVB(~'' _ „~~ ~ ~ Notary Public -State of Florida REQUIREMENTS AND CONDITIONS. 5 • ;`, . oe, ^ 'N~ My Commission Expires Dec 6, 2011 l 17 R~~~D ~• l /1~ • DATE i~OF F~~~•~ ~,,,,,,~~ BondedThrou hNationalNo0 Assn. g . r._._._ _ %r - -i,. CITY OF ATLANTIC BEACH ,,J ` ; '1%' ®WNER / BITILDER AFFIDAVIT --- 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: STATE LAW REQUIIES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT 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 AONE - OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IIvIPROVE A COMMERCIAL BUILDING AT A COST OF $25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION I5 COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOtTR 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. 111. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN "OCCUPATIONAL LICENSE° IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT (247-5826) IF IN DOUBT. V. ACKNOWLEDGEMENT; THEREBY 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. ADDRESS ~ ~ F~ 7~ ~~~ f ~ PHONE NUMBER PRIN~T/NAME Y"'~ SIGNAT RE DATE Before me this ~~ ay of ~ u ~, 20."l~ in the county of Duval, State of Florida, has personally appeared herin by himself /herself and affirms that all statements and declarations are true and accurate. 3 ~°-®` ' Notary Public at Large, State of `~ ' 'I "~, County of - C~hl'1~ ^, ~Personally Known L9 Produced identification - ~ L -1~(_. `~~PRY p~B.,~~, REBECCA MENDEZ ~?°,r~*~~ : Notary Public -State of Florida * * c My Commission Expires Dec 6, 2011 •~ ~. ~; ,, , P Notary Signature: "~ o~~ ~ ~~0; ; ;°~~~`` Commission # DD 740172 Bonded Through National Notary Assn. FBLDG/Owner-Builder AfEadavit; REVISED: 4/16/2009 NOfiICE OF COMMENCEMENT (PREPARE IN DUPLICATE) Permit No. ~ q # ~ ©? ~ Tax Folio No. State of F?b R i YJ FT County of n~ v cr ! To whom it may concern: The undersigned hereby informs you that improvements will be made to certain real properly, and in accordance with Section 713 of the Florida Statutes, the following information is stated in this NOTICE OF COMMENCEMENT. Legal description of property being improved: (.o"C ~ ~ ~IAC~. G 3 'T~~ ~ ~'~-~ Address of property being improved: ~ q t7 ~ ~ ~ S~~T General description of improvements: EtJCi~ 5E 51 OE 1~00.~~b'I --- Owner ` L Address T ~ G Owner's interest in site of the improvement ~ ~ ~' Fee Simple Titleholder (if other than owner) Name , i~~1'/~ Address Contractor ~~ ~.n Address Phone No. Fax No. Surety ~f any) Address Amount of bond $ Phone No. Fax No. Name and address of any person making a loan for the construction of the improvements_ Name Address _ Phone No. Fax No. Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other documents may be served: Name ~ Address _~ « Phone No. Fax No. In addition to himself, owner designates the following person to receive a copy of the Lienors Notice as provided in Section 713.06 (2) (b), Florida Statutes. (Fill in at Owner's option). Name Address Phone No. Fax No. Expiration date of Notice of Commencement (the expiration date is one (1) year from the date of recording unless a different date is specified): 4 OWNER ~ Signed: ~~~~'~ ~ ~ DATE ~ ~ ~ ~ ~` Before hie this day of in the County of Duval, State of~lorida, has personally appeared ~-~,~ t G"~ l~ herein by ~~~ .~ himself! herself and affirms that all statements and tleclarations herein are tn~e and accurate `~ ~ ~ ~r.,,.~a l~r v'r fdoiary Public at arge, State of - ,County of ~ ~ Gn__;'i My commission e>:pires: ~i~ i12s; (,; °L~ ~ Personalty h'novm °f Produced Identification ?~ ~_ ~- ~ t mc: "'~~o °`o'~• ~ ~ o c o d ~3~.Lm N' ~ ~' C7 z~ m~ ~ ' a ~~~ N~ ~o~^:m d v H m zv o~t A ~ ° m `C p n •n N od 7 N N G CITY OF ATLANTIC BEACH PRODUCT APPROVAL SPECIFICATION SHEET (short form) As required by Florida Statute 553.842 and Florida Administrative Code 9B-72, please provide the information and approval numbers on the building components listed to be utilized on the construction project for which you are applying. We recommend you contact your local product supplier should you not know the product approval number for any of the applicable fisted products. Statewide approved products are listed online @ www.floridabuildin~.or>; Category/Subcategory Manufacturer Product Description FL Approval # (s) EXTERIOR DOORS a. Swinging b. Sliding c. Sectional/Roll Up d. Other WINDOWS a. Single/Double Hung W~1~.Q S ~.+~-c' (.~ L 09 ~•3 b. Horizontal Slider c. Casement d. Fixed e. Mullion f. Skylights g. Other PANEL WALL a. Siding b. Soffits c. Storefronts d. Glass Block e. Other ROOFING PRODUCTS a. Asphalt Shingles b. Non-Structural Metal c. Roofing Tiles d. Single Ply Roof e. Other STRUCTURAL COMPONENTS a. Wood Connectors b. Wood Anchors c. Truss Plates d. Insulation Forms e. Lintels f. Others NEW EXTERIOR ENVELOPE I understand that, at the time of inspection, the following information must be available to the inspector on the jobsite: 1. A copy of the product approval. 2. The list of performance characteristics which the product was tested and certified to comply with. 3. A copy of the applicable manufacturers' installation requirements. Further, I and an a product may have to be removed if approval cannot be demonstrated during inspection. ~~ J CJ t pplicant Si ature Da e H:/Product approval spec sheet short form.rlsx ~a DEX QF p~WINGS IN_,_., Site Ptan SHEET 1 T 2 SHEE Floar Framing T 3 SHEE East Eie~ation T 4 SHEE Building Section T ~ SHEE South Elevation 6 SHEET No~~ Elevation Structrual changes ,~ pg+plE~T ~ ~° TIC nstall dew Windows I Install new siding Replace door T pe of construction ~ ancY Qccup Basic W ind Speed Wind Exposure Wind IrnPo-~ance ~B R3 12~ ~i C~~ 1 ~ CatagorY Ii =-- EACH ATLANTIC B gpLE P~RCHervices peter Coalson Desig e Code 2007 ~.O"` 1 /rl~~-1 F1t~r~da....~---rr ~~~/, ~~ ~ ~~-z ~~~"/~ ~Zl/a!° MAP SHOWING BOUNDARY SURVEY OF LOT 16 BLOCKS 63 ACCORDING TO THE PLAT OF AS RECORDED IN PLAT BOOK ~10~,o PAG (5~~~ 11 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. CERTIFIED TO: BRUCE BOLE, KATTTERINE BOLE, NAVY FEDERAL CREDIT UNION, GIBRALTAR TITi.E SERVICES AND FIDELITY NATIONAL TITLE INSURANCE COMPANY. S/XTEENTX STREET (POST£llf car) 16~ £ N (~ R~+1 So.Q©' rR~ II ~.~' (~,, r PAVEMENT 1_„ 2" ~ _. ~ ~~~, f CONC. ~ ~j ,,2. LB. 8645 0~. M1O0D . .~ $ ~ ~' N t1TEP N 1 t.K G STEP CO BY d . It.2'.. ~ 0.7 17.5' 27.3 WOW O STEPS +6 A/C PAD 11 S' 5' 3 . . YAOOD ~ 0.5' n ~D ~"`~~ ~ 1 STORY fRAM~ ~ BRICK 0.1 ~ Y ,~ .~ ~ ~ TEPS 0.2' ~,,,, ` O ~ Q, N D.2' ' Q O 0 w ~~ 0.2 q C1 `. ... Q 0.2' ~ ~ ti t5.O' 24.0' 1. ``~ ~ O W LOT 16 V BLOCK 63 G. Y .. .28.0' ~~ 0 21.t' 3' EOCE OF ~ q ~.. ~ FRAPE • ~ ~~ d . f a GARAGE PAVEMfliT n Z9, • . ~ ~b'3~~ia9'.... a a ... ' ' ' 9o ~ T7D 0Y ~. t.O t.t' 1.3'~ 1/2' 1 49.95' (M 50.00' (RJ ' LOT 9, BLOCK 63 rtnm tax x' - ALAS a7snnRn m ee tlu7soE 7NE axc AIWAL auwt~ flAaD ru14 / 7!L00D tax 'x 7 . A7E13 a' o.u enNI7N. aw~a aaao; A1xAS a' ~: AINUAL aw7tc rtN Ar87ACE otP77a aF u:ts tKAN 1 root as >r7x mArAaE AgEll4 ~E93 aow ~ SOIrARF raE; Alp rROTEY:Im BV IEtRES FlIOY 1: AIrAU~ dwNME Ftnoo. K m S` 1. ANGLES ARE SFK)rAV ON THIS SURVEY. 5 2 BEST 0EIERYRIEOIfROY F~E~Y.A. FL000 YAPS PANEL NO D! DAiED4F't7-t989 A SSMC{ATED SURVEYORS INC. 3. THIS IS A SURFACE SURVEY ONLY. THE EXTENT of UNDERt;<20UND FOOTNrGS, LAND ~ ENgNEERING SURVEYS PIPES AND UTtUTlES, N' ANY, NOT DETERPINED. 4. JURISOICTKXVAL ANO OR EN4IRONPENTALLY SENSITIVE AREAS IF ANY, NOT 3846 BIANDING 80Ul.EVARD lACA1ED BY TENS SUR ~ s ~ JACKSONV1l1E, FLORIDA 32210 5. THIS SURVEY BASED ON LEGAL DESCRIPi10PfS fURNI5HE0. THE PUBLIC ~ ?~ 904-771-6468 RECORDS MERE NOT SEARCHED BY TLLIS SURVEYOR FOR EASEPENTS, TITLE, J 0 O CERTIFICATE OF AUTHORIZATkkI N0. LB 0005488 COVENANTS' B.R.L'S RESTRN:TIONS, CLOSURES, TAIONGS OR ORDINANCES, ETC. S S V THERE COULD ~ OTHER PATTERS ~ RECORD THAT AFFECT THIS PARCEL. D7c0 ~ •vccnr n wucv^ no i o a.ao 1 P T - [N7Wt K TPI(Y'YPY I /pl . OGbOfl r-i U CLf 04 U .,_., ~ ; a-~+ di a-+ n~ .~ .~ . ~, i~ O A~ V/ 0 ~~ ~+I .. ~~ Bole Porch L /plcLl o" _1_ p~AN ,c~~e ~~~, F1-pOR ..~----_- ~~, s Atlantic Beach ago lath Street ~`, :,~ ; ,; SH -1 P~}~~ p~Y ii--- .~ ,~~, =- -- EAST ELEVATION 1i2" =1'0" PC ID S Bole porch 19o i6th Street Atlantic Beach SH - 3 Existing ~°°f Existing ~°°f 2.2X6 Header Existing ted Window New Insole New Insulated windows .~ Existing 4X~ P°St brain Roofing New roofing ...r- Single Mem ._-- 3x4 „Sheeting -~- 3X4 „plywood „ Iso rigid insulation -,__-- 2 ._' 3x~„ plywood ~- 2X3 Fram~raming Existing Floo asony ,~oundat~on Existing M ale 1t2" _ 1''0„ ~ SE~,pN S~ .~-- ,~vI~pIN RQ~.~ ~Q~C~1 r Storage p~ 'rim _~~_ ON ,~~2„ ii,, fl„ QR~ E~E~ A~ N _--=.. trees -atlantic Beach ego 6th ~ r , . ..,~. 4 ~ 5; ~ } SH -4 dew paor New In~uiated VVindo~s dew r~ofin9 Hare ~°ara S~d~n~ ~~ ~~e porch B .~~~_~~w _ __-- pT Trim N ~ ~ ^14 _ ~1..~ti ~~ E~~.V A~C3 5 _.---- °----- Atantic Beach SN "`- ~90 ~bth Street -~ ELEVATION ~,f 2„ _ ~,_~„ NOR ___--_-- Sole Porch rC I ~~ ___-- 190 loth Street Atlantic Beach SH -6 s~-r~ ~~~~~~~..~ MAP SHOINlNG BOUNDARY sURYEY OF iar es e~ ~~ ra n~ Pur ~ ~s R~corea~o ~+ Pur eaOx ~a . P~~(s) » aF TM~ cua~M PU8L1C RECaRCS OF DUYRl. C4tli~1'Ir. fWRtDA. C6STiFiYD TU: BAtiCS 9aLB* KATIIEB.II~E BOLL, NAVY FEpBRAL CREDIT UATOlP, &i8&ALTAR fiTTLE SERViCtS A1tD PIIM4ITY NATIOHtAL TITLE LHSDSllitCB CSMPAl4Y. N n f S/XTfE/VTH ~FI~EET llr"' SIAIEL'r (pIATJ ~aoa~R) ~~• . '~ ~~wL'"~t ,, ~,o ~a,~r.+c,~ ~~ ~~ ~ o~~ ~~ r d i 3 `~~ ~q ~'1 COT 9, BLOCK 5J ~AMAR ~! a 1L1 AIM1 ~ ti1M I~~t t/~ 11AY ~ ~i Mik A~ ~~ It16f il~f ~ ~MML OIMQ NAr. R ~YIL A asac~i-tEO s~vEYaRa ~c. WW • ~ 3UAYE1'S ~ .IAt~SSONil~1~. P101~11 t~2 @ .t so+-»~-~ae a _ ' ~ ~#1PJ1TE OF NliIIOpDAl10N NR t6 00051 1. AINYi a ~'S110R1 Qi TIIS .'S1~I~Y Y ~~ .?. 1Nt.~f~. 51~11~ {N:g4 ~~ f10tg ~~.~..~.+~ WS1 ~~ PMII F.ENaI a~ yAPS PAlil. iNl i Ham-f7-i~D J~ 1MI.41S A SIMiFAO~ SiIRYFY ONLY. T!t Ot1O1T OF tINQfRO~tIND iOOIiU.'4. PEES Mq UMl1KS- ANY MOT . f. ~A4 ~ pf~IllOIYErITALLY '.~113i1i~ AREAS i ANY, MOT 9 MS St~lYEY 9115m tl!! LE6Al. pESCgP110N5 ftN~ED. 1HE P!lgiC REAOMQ'S N~ NOT SE111IdED ~ SiKS 9vlYEYOR FOR fJ~SfJ~6MTS. ifRE. ~~~~~ ACRE OOiMt1 ~ QTFEyt iNtT1t70+ ~ NE001lD AiAT AFfiJCT BSS PARCEL. e.IINLYS 0 STA7D1 ALL 140li PPR fdRO FIAt~ NO OET[IiiCAAa1. 1 NEAEBY CE#t10:Y T1i15 Suiritlf WAS OONE UNDER NlY L~O~VAO~YMTEOMO DWELT SUPERMD0ON AND MF~I'~s ~ MINAtUM TEC~NCAI. n err ~ .~s +w w+~a .~.c . ian n ate[ ~ a =Drib ~tm> ~1 Q a ~° ~~ v V b ~ ~ Z ~ ~ A ~ z a~ ~ o ~ ~ 0 ~ ~ a -i~a•~ , -City of Atlantic Beach ~3 '~'~ ~~ Building Department ;r 800 Seminole Road s> Atlantic Beach, Florida 32233-5445 J Phone (904) 247-5826 Fax (904) 247-5845 =~~y;3 ~r E-mail: building-dept@coab.us City web-site: http://www.coab.us APPLICATION NUMBER (To be assigned by the Building Department.) ~OZC~_ Date routed: ~ /~f(Q~Q APPLICATION REVIEW AND TRACKING FORM Property Address: ~~~~ /~' Applicant: ~lC~`77 ~ Project: C~D~~n ~ ~ ~ ~orC l~ ~ - ~l n 1~0 ~ Review fee $ De ent review required Yes No uildin Planning & Zoning Tree Administrator Public Works Public Utilities Public Safety Fire Services Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified B Date Florida Dept. of Environmental Protection Florida Dept. of Transportation St. Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: Approved. ^Denied. (Circle one. Comments: BUILDI PLANNING & ZONING Reviewed by: ~ Date: ~~ / ~'~9' TREE ADMIN. Second Review: ^Approved as revised. ^Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ^Approved as revised. ^Denied. Comments: Reviewed by: Date: Revised 05/14/09