Permit 1025 Seminole Rd Doc # 2010055648, OR BK 15179 Page 746, Number Pages: 1, Recorded 03/11/2010
at 11:33 AM, JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00
Mar 01 10 08:24a Clark Foundation Repairs 904-284-8088 pA
NOTICE OF COMMENCEMENT
Permit No. a—j21 2. Tax Folio No.1202 if-000 0
State of Florida,County of Duval
TBE UNDERSIGNED hereby give notice that the improvement will be made to certain rest pmperty in accordance WM
Chapter 713,Florida Statutes,the following informatiesn is provided in this Notice of Commenoememt
1. Description of property(legal description of property and address if available):
&0-%yj.eP14t L��UL-ql .,slt tjQ '1��S.�f} Armin• '-!-j figany:-/$aP,&V, 4.311 -6'•C'�4
2. General Descriptionofimprovansom:InB � P.i G*g'' ST.FFOdP Su«S 7b Fervv% OP.9»j Wcu.rs
•bake anJ fa dud '.+ iG„!.fe Se—Thal I, ZTQr.e. eALO-C f- Sa<.•n7 9144-1 SILL Cy 91evy.S
3. Owner Information:
a)Name and Address:/• `LL'jkg%J+ €leas 32.Z33-S Z7
b)Interest in property: _1.n W r
e)Name and address of simple*Icholder(if other then owner):
4. Contractor Intonnatiem:
a)Name and Address: 9 P. tjeL F S ./L &a., ?C. 320`
b)Phone Number. 904. V9- 7 t z!
5. Surety Information:
a)Name and Address:
b)Phone Number:
c)Amount of Bon:S
6. Lender Information:
a)Name and Address:
b)Phone Number.
7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as
provided by 713.13(lxa)7,Florida Statutes:
a)Name and Address ,x o
b)Phone Numbers of Designafed Person:
8. In addition to himseWherseK Owner designates of to receive
acopy of the Lienors Notice as provided in Section 713.13(1)(b),Florida Statutes.
14 Name and Address:
b)Phone Number of person or entity designated by owner:
9 Expiration date of Notice of Commencement(The expiration date is one(1)year from the date of Recording unless a
different data is specified:
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE
NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART
I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR
IMPROVEhI NI'S TO YOUR PROPERTY.A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
P09MD ON TSE JOB SITE BEFORE TIIE FIRST INSPECTION.IF YOU IIdTEND TO OBTAIN FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING
Y U�NOTICE OF COMMENCEhMM.
Signature of Owner or 's Aathonzed OffieerMirector/ParwwftAanager Signatory's Printed Name&TitWOffice
The foregoing instrument was acknowledged before me this 1_day of M=A ,20 /0•by
41,11, 1M F a..s as for-- - I✓IA
(Mme of ice) (T� :
Al f' dame o emt was Rcecwed )
MYCOAMk�II�'1ifDD5625,2
EXPIRES:June tt,2010
maetm,r+amyrwwum.M�:
`I y CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
' ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
R�
Application Number . . . . . 10-00000232 Date 3/09/10
Property Address . . . . . . 1025 SEMINOLE RD
Application type description RESIDENTIAL ADDITION/ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 9200
----------------------------------------------------------------------------
Application desc
plates to support floor
----------------------------------------------------------------------------
Owner Contractor
------------------------ ------------------------
DIAS, WILLIAM F. E. P. WOLF CONSTRUCTION INC
1025 SEMINOLE ROAD 3826 SR 16 WEST
ATLANTIC BEACH FL 32233 GREEN COVE SPRINGS FL 32043
(904) 529-9289
--------------------- Structure Information 000 000 ----------------------
Construction Type . . . . . TYPE 5-A
Occupancy Type . . . . . . RESIDENTIAL
Flood Zone . . . . . . . . ZONE X
----------------------------------------------------------------------------
Permit . . . . . . BUILDING PERMIT
Additional desc . .
Permit Fee . . . . 100 . 00 Plan Check Fee 50 . 00
Issue Date . . . . Valuation . . . . 9200
Expiration Date . . 9/05/10
----------------------------------------------------------------------------
Special Notes and Comments
*2007 FLORIDA BUILDING CODE W/ 105- 106 SUPPLEMENTS .
2007 FLORIDA BUILDING CODE - RESIDENTIAL.
2005 NATIONAL ELECTRICAL CODE.
*SUBMIT "CERTIFICATE OF COMPLIANCE" BY A LICENSED PEST
CONTROL COMPANY PRIOR TO C.O.
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 100 . 00 100 . 00 . 00 . 00
Plan Check Total 50 . 00 50 . 00 . 00 . 00
Grand Total 150 . 00 150 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
JUL-23-2001 04:54 FROM:CLERK OF COURTS 904 270 1512 TO:92475845 P:1/1
Mar 01 1U W;248 uiarK reunuauun mepriiih
0
NOTICE OF COMMNCEMNT
pernolt No. Lp –D ,�,a,,,., Tex Folio No. 12012 OOD O
St jz of Florida.Coulaty ofDuval
TW
LJNAFRS10N1 )b by give notilce*0 the improvement will be made to certain real p�OMq im accordance�vhh
Cbaptcr.713,Florida Statutes,the following iAfosnXdCG is Petivided In this Notroe of CommencetnwL
Som. Ljcretipteon of prop" (legal dese%iptic>mt of aty and address if svailabie):
• _6
~ e®eats:)n67 x.4 P•f G",cs'` 5T.FFog+' S:tc 5 76P�rrr% p• An•i c�c.g,
2. General Deser4gion of Ilmprov
a@bie 19.M to dt d& 4—.641' t,Sa_� 'N s��O&K rA to s w "r-d"a
3. Ovgmor Information:
a)Nam and Addrioss: .DWS ICU Sir in t+eL&Lj 01AUL r.04 PAIL 3273 7 -S'•5 e.7 '
b)Interest in property: '
e)Name acrd address of simple titicbolder(if other thmin owner):
4. Couftwtoolr haformation: .,
a)Name and Address: 9 D t..Vt_F L'amS1�-�e.GhinZat . %9,2 L .S �G ttse i N L"wE one a 3Aoy
b)'Phone Number.• !Z 17A
-
3. Surety Information: Loo 0,201 C&t6o-d.uk r7h 15179 Page Tot.
lt)Name and Adams: Number Pages:1
b)Phoma Nulnnber: Recorded 03(11+2010 at 11:30 AM.
JIM FULLER CLERK.CIRCUIT COURT DUVAL
c)Amount of BOO&S COUNTY
RECORDING$0.00
6. I ender Information:
s)Nmnc and Addms:
b)Phone.Nuinber.
7. pamon w1aft the Stake of Fiorida desigsuaftd by owner upon whom notices or althor doclm►e sda nosy be served as
provided by 713.13(lXa)7,Florida Statufees'
a)Name and Addma— f P13
b)Phone Numbers of DesigmW Person: . E
S. in addifmto hinomIfterselt Owner dosipates of to noceive
a copy of the Liewes Notice as provided in Section 713.13(1)(b),Florida Statutm.
a)Name and Address.
b)Phone Number of pawn or tmtity designed by owner.
9 Expiration date of Notice of Commencement(lbe exQiratkm deme is one(1)Test£tom the daft of Recotd'urg unless a
diff+cat date is specified:
WARNING TO OWNER ANY PAYMENTS MADE BY THE OWNER AFTER THE E iJPIItA MN OF THE
NONCE OF COMMENCHMW ARE CONSIDERED DeROPERPAYNUZM UNDER CHAPTER 713,PART
I, SECTION 713.13. FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYIN O TWICE FOR
IM's OVEMZ�;TS TO YOUR P'RO1 RRTY. A NOTICE OF COM AWCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SITE BEFORE TkIE FIRST INSPECUON. IF YOU INTENT)TO OfiTA N FINANCING,
CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE C0104ENCING WORK OR RECORDING
YOUR NOTCCE OF CONUVIENCEMEM.
S ipature of Owe or dwner's Authoazed OfBeerlbiesotorlPatt w Memagelr Site's Printed Naallee&Titletof ce
'xhc fbmpiag instrument was acimowledged before me this—L_day of Ma=A ,20_ /0,by
�f�,, ff A��L21" 15 I� s as for AI/A
O I �>nno o��eeat vras 35xecuted for)
�15
'/1� WCOMMISSION M DD 162512
/f''�! EVIRES:JUN11,2010
. �.A/"!%4fP-0r�
03/01/2010 15:38 FAX @002/003
Mar 01 10 08:23a Clark Foundation Repairs 9u4-2134-butsts p.s
1. ATLANTIC SEA
txry of 10-
M&MMOLS AC
pr.Jara•poeyle'r�e2e.fwK a16
BUILDING PE r APPLICATION DUVAI-COUNTY
WOW
41L1E� r"' ercuMf>Fwoge:•' ;•r... !: tlbt:tlP
y / D►towIRR lwa f1PMfatlKal OFI�I�ti'M
�( K SlA VAMffN3N aCOWERTMWE MIMEM
L o�r�nnfeoN Vial l: a At.TERATIQM fl�coestasltr etrrril IL FIRE onetlNp
a prtPAIR o r ewe o vt s G e+w
s Q ND WMNEW
_.
1 a►NIS 1S 'NRI1� 21. NN WNPANAME
�.
NAME .. �•.r�c..are+M/eA�
gA
'Q
SOD 1 .eTATCORPt,OttleA UMIIIIZE NW 6TA t1F Md
ID rS�r1'1i rwLL Ptd• ��ao e:
,eAe01 1Ma$AG sa. ic. e�sr
11.O�If�Pr10HE S2 PI:L' w.0 PFIOr+E ilNi W1 dowr7kim ;
V.OiFrCB PHOW ae.PM NW,
1a CELL Pl1epG A MLLPNON6 RL claw.PHOM
14,NA IIL AWNEI a: B W LAl70RES�i w 3L UAL At PAM
'i' iwwawiiMr Ism '' ,OOetO �OO�IIL/ytlrt.v �ti, 'AIQRIGAOELtC•
31.NMF: 33 NME Lia IMMB
3s ADORBaiGc SLAUMEti.9: 39 AeolttW
Applialm to hersby Wade to obtain a paretlt to do the week and 401111 atlarw tl IndlOM& I =01 thtt nr
III work or Ira4n
ellon n
commenced odor lotee isawnce ora ponndt arld that all wort aaie paeibr bod to meet the standards of al Iowa Te9ulebira oonsbu con In this
Pabelogon. Tlda perrMt traopraes rxdl sled Void If work Is nm aonarwnond wtadn abr(8)MOM q, or r aonstruWon or watt Is suspended or
abaredgawd for a perlod of abs(e)manta at any lime after wok k commenced. I under dwa that sepwab permta lienee be seoiaw for
Eleetrleal ttYork,plvmwnff,s%M ttlfelle,trop Fu flollafe,Haabw%TznI Ak Coe.daao etr
OWI AFFIDAVIT,.-I amfly 00 a1 Out,fonvoitg hl mabon Is accurate and that all www wa be done In complanm wan el appikable
Ism metAaldra mnakublan and eonlI I will not can&"or use Lha nftftaeed buarant or any pact thwK will all InspeclIons are*shed and
ptler to oblakiktq a w aeste of ooeupanry or empta8on MOM by the bulidMlQ oladel,as r11411I 11 by bw.
*** WARNING TO OWNER: ***r
YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT N 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 FINMCING,CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
• ,,. ._•,.::..;:.p��bf �',R.:_� ;':q�;.�: _?• ;;,� . .'•v��:!':. .•,rp Vii':.: _ •
6laied: Oa1e:J /—�0 8bna1' bur
Belle pre ars.-. -fpr at ZM In to eerily of OEM nw arY dirt d 2 ll o in the a OY*d
Ou"NO of FbM&lis pemWv*eppsared DwvA Siete 01 Fla I has peesaneay"psw ea
k, 1/A.11 F. -D�IIIIIIIIs /�w lgrL "r-, ZDm/Y—,,
herr by hinMNf herWwd @IfMR1i that ea statomeefs argil dwWaII are hMn by hlrrere/J hareefl aid athrne emu as stdonwnli and dedbrellaw era
MI a ar4somrela.
tVoh"Ptftac at Large,9108 OF Couey ol Nally Pul tt at Laps.Stele d 1 cm"
�P�.ner.gr lawn e�vsrene,a w�.n+
Pi�a rre �� •
NWA, p4I slaedurs:
CARM411E .�`��"` 'ti. MARTHA S. CLARK
FRD 012 : teary Public State of Florida
CITYOF �• i TWA" " � y Com SaFapires Nov 192ot2SEEPERMITS FOR ADD .• yComhi 'on*ODNT
ITIONAL Httallla► -e A, ,`,
REQUIREMENTS AND CONDITIONS.
� w
REVIEWED BY: DATE: -�y:,o AdO3 3I L E OPY
� F
�.*� Inr'�f!:;'r''•�r}'?d!'�,+.'�1nS�s;T+"iNSYM.•"Mu�uMwwwtiaMr'nN OVM _ ,i...,
03/01/2010 15:39 FAX @ 003/003
Mar 01 10 08:24a Clark Foundation Repairs au4-tts4-twt10 p.w
NOTICE OF CONMMEMENT
Permit No__ Tax Folio No. WD0361 0000
Staim of Mmida,County of Duval
TSE UNDERSIGNED hereby give notice to the impmvement will be made to certain real pmperiy in accordance with
Cbagter 713,Florida Stattmas,the following mon is provided in t}tis Notice of Coum=wement.
1. Description of prroperty(lcgal deseziptiau of properly clad address if available):
5
00'nAX 14U gels tt L ,I Safi S .SQA%:n,Lr�e��s•+� 1�Fl6�►�L.�:t J.
2. General Dmadpdun of uaproveam `=:inS GL(- Ari Gte/' S1%FPgie+► 5:4�S Fie Si . top.
p• And Rrj(x.0'_
fEhakp enj f8 r�pr,—Se-Th J n SZM L o ra+s tZ _V!" C
Rja_424 L2 S tLL __ 9 l rH
3. Owner Infa nOectiion:
a)Name and AddrMss: ,3 t LL l tan► :AS fQ'.'1S�Qan:nB(.� .�I ):a 1Sa Ae� L• 32.7,3 3 -S x�
b)Interest in prwertr-_ f
e)Name slid address of si�k�eholder(If other than owner): -
4. Contractor Information:
a)Name and Address:Jam. L�Br=F L°anC r���%,i»Z _ .?g1 L Sl�16__u,+asi � ,. Cwrt ens �c 3,
b)Phone Number:, qey- W19 :7 171
S. Surety 1nEormation:
a)Nance and Address:
b)Phone Number: i
c)Amount ofBon&
6. Leader 1'nfornoation:
a)Name and Address:
b)Phoao Nufztber:
7. Person within the State of Florida designed by owner upon wtwro notices or other docrno =ds may be served as
provided b9 713.13(Ixa)7,Florida S't uMcs:
a)Name and Address- o
b)Phone Numbers of Das*mfad Person: 9M. rfir- r
S. Iia addtion to hi=aWherself, Owner designates of to zecerve
a copy of the Lienor's Notice as provided is Section 713_I3(1)(b),Florida Statutes.
a)Name and Addwas:
b)Pb ono Number of person or entity designated by ownar:
9 Expirnion daft orfNotice of Commencement(The expiration date is one (1)ym SVM the date of'Rtcording unless a
different date is specified:
WARNING TO OWNER ANY PAYTAM TS MADE BY THE OWNER AFTER THE WIRATIoN OF THE
NOTICE OF C01Q4ZNNCEMLNT ARE CONSIDERED DAPROPFR PAYNONTS UNDER CHAPTF,R 713,PART
1, SECTION 713.13 FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE Fort
D&ROVEbOMTS TO YOUR PROPERTY. A NOME OF COMMmUNT MUST BE RECORDED ANI)
POSTED ON THE YOB SITE BEFORE TEEM FMST INSPECTION. IF YOU MEND TO OBTAIN FINANCING,
CONSULT WITH YOUR. LENDER OR AN ATTORNEY BEFORE COh54MC1NG WORK OR RECORDINQ
Y NOTWE OF COMM4MMEM. I f
Dw - ovo.'(
Sipature of Owner or Clummes Acw/13keeW/Pafter/Manager Signatory's Printed Nasse&Title/office
The foregoing instrument was acknowledged before nw this�_day of MaejcA 20 /0,by
1,111 jim if I) s as for J✓IA
s of Parsers) ( S , . N cam Party Mau=ML was Hmuted for)
un
M1�� s COIIMIIISSI t OD 562512
(q EXPIPES: ReNe 11, 010
- I
6andk Tlwoaqj Nry iuuedamndenvreor6
_ r
r
i
_ t�
i - ;moi . . "°�-:�--- �—.�• .- ."-�- -`` ';.���_ .. . . . . _ .'
AI
. ter. i:. E "�Ir .� 1 I i � 4 i .� _T^�•,Y t� ..
, .• . . ,>AlRp
(- 4- •yam-y�- _
•.�`� •. tt'7:,-'N �`�---��-�•-+-v�:F.e•�•Y..r�s-1 -••Y.r ,��._,.�"",,,+d�. ..�..ri•-�_.�s�-. .,ri.- -.- 1 !` _
IIJ
fit i. (". :.:S = .I ..�r�.�.. .t: ".��_s �• _
• .i':f�`.V •. .i. 31 .F .�Y 1 i i II'. r _i ! s ' �• �i 1-�'•• - '•
• ,fly. '�� '1 . 1 i � , ; 1 • �: :�' ••I I •- .- '.
rim
a
ix
M .
H �
c �
� .0_ v -n `t � • to - I �.'
x ( I
1
... 9 0 4. r—a _ — _ 27-n•.
atA1
Duval County Tax Collector Page 1 of 2
ray, '
i
R.
Tax Record ^�
Last Update:2/17/2010 10:51:14 AM ET
Details
Tax Record Ad Valoreran-Taxes and Non-Ad Valorem Assessments
Print View "` The information contained herein does-not constitute a title search and should not be relied on as such.
Legal Desc.
Shopping Cart Account Number Tax Type Ta
Payment History 170095-0000 REAL ESTATE
Print Tax Bill 'NEW[
Property Info. —► Mailing Address Physical Address
DIAS WILLIAM F 1025 SEMINOLE RD 32233
1025 SEMINOLE RD
Searches ATLANTIC BEACH FL 32233-5527 GEO Number
Account Number 16-2S-29E
Owner Name
Mailing Address
Street Address Exempt Amount Taxable Value
See below See Below
Site Functions Exemption Detail Millage Code Escrow Cod
County Login HX 25000 USD3
Welcome Hg 25000
Tax Search
Local Business Tax Legal Description
Privacy & Usage 16-2-S-29E 1025 SEMINOLE RD 16-2S-29E ATLANTIC BEACH S1/2 LOTS 44,46,48 E
3EANNE M O/R BK 5113-598
Contact Us
Home Ad Valorem Taxes
Taxing Authority Rate Assessed Exemption Taxable
Value Amount Value
CITY OF JACKSONVILLE 5.4480 173,109 50,000 $123,109
ST JOHNS RIVER WTR MGMT DIST 0.4158 173,109 50,000 $123,109
FL INLAND NAVIGATION 0.0345 173,109 50,000 $123,109
USD 3 3.1553 173,109 50,000 $123,109
SCHOOLS 7.5820 173,109 25,000 $148,109
16.6356
Non-Ad Valorem Assessments
http:✓1fl-duval-taxcollector.gover=ax.com/collectmax/tab collect mvptaxV5.9.asp?wait=... 2/17/2010
.r.LY 1Y YY YV I n1% �j 002/002
'`�M1YtORM waeeRlT ossv-•Iso ftreffApC1^%MP 1Wn QJI~W
VOL 51D ►r, IL"�.CC�I
^FFICM ,r��o�1n� my Deed
THIS lNDE11)TIINA Made thio 15th day at May A.D. 39 BO BETWE
ADA CONE. unmarrl.ed
at the C9ualy al Duva 1 &ato Florida r part Y GC the fust part, and
WILLIAM PANCIS DIAS and JEANNV M. D AS, his wife
Whose mailing address: 1025 Seminole Road, Atlantic Beach, Florida 32233
of the Comty of Duval , State of Florida part ies of the second part.
WBM 111111PSt That flu said past Y of ttta Ota%part, for held ie eonaldwatien of the sum of
TENAND NO/100---------------------------------•------------------•---------37olters,
to he r in hand Vold by the said p•t•t i es as the*"end part the rer.ipt whs"W M hereby stMaw.
tedged. she has granted,b tsiond tad sold to the efid pact les of the second part,
their he'n and eraig" forever, the following de mlmd lend,utuata.Iyhig sod being in the
County of Duval ,State of Morids, to wit:
The South 1/2 of Lots 44. 46 and 48. Block 13. Plat No. 1,
u Subdivision "A", Atlantic Beach, according to plat thereof a N ae
w recorded in Plat Book 5. page 69 of the current public records o to~
of Duval County, Florida. n
�± 4 ern
M Subject to easements and restrictions Of record but by their p `s
Pd M reference they shall not operate to reimpose same. w y
to Co m.4 Subject to taxes for the current year. v'
N C] N N C
C m 14 Subject to that certain mortgage to Beach Federal Savings and
sr. 0Loan Assogo Pqciation dated June 19. 1973 and recorded June 20, 1973, +-&
0 In Official Records volume 3534. page 306, of the current public a
eta records of Duval County, Florida, which the Grantees herein by
tt a V.a o the acceptance of this conveyance do hereby assume and agree to 0
pay-
t 0% ,
X
And ttae said part r Y od.the fuw port do es hereby fupy wUCM the tale 10 Wit widefe>s
fasad ll d
i s -ap &Me sachet the lavrfnl eishm of all parsoan wbo moover. ce),
1,14 IN MrIUSS W111111111181M. the eaild part y of the first part he S lionmato not her hand and
11L Rd
the day and yeas fust above written.
k 1 NIGN&D AND //I//I,��N� OUR 1
1l W�';,1 '•�
till ta,jlj1'
---
---- ... ------------ --------------------- (SEAL.) `
mom
;`�0 0111111111 �� -- --------------------------------------------(3><AAL) \
-.��------------------------------—---— -- _ -
STATE OF FS.ORMA 1
coUMM Cly Duval- ---- j
BeZose enc peraoaoUy epperrvd _—Ada Gane L unme -----------i ---------------- x----
a+XWt-----------------_..._-.—.._.»�.�_ ----—--------------- jf, to me wsII kmrwo
and knmm to me to be the iudivida•L- described IA sad who ozoo fad rho foraaairtg Instrusaset, sad
a m wb 1112M to and before one Haat -_.shea...,ed be same for the purpsees therein expressed.
WTft;M my hand mad oQidal seal this .....l5th ---------day of-- May------
Jaeksonvrl�lrl�+ -'
i9..8D� •t �o=•--VV eBe1 IVBeach------, tensity and �' �
MAIL 15 -A Iz PH 48[, J990"rtrwla in end for the odamtr -f
M7 comp"ireiom expires'
rp LU PJ..k-.Aa,r:,licit%
:•x:ni•r6 NvAI1,�Wt,FLA
. ewetrmYs�
- �a�V
City of Atlantic Beach APPLICATIt3N NUMBER
Building Department
n' [Date
o be assigned by the Buildin Department.)
800 Seminole Road ;14
r� Atlantic Beach,Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
.�.DRI 9� E-mall: building-dept@coab.us routed:
City web-site: hitp:1 www.c oab_us
APPLICATION REVIEW AND TRACKING FORM
Property Address: �l'/� �E�1 `�10�� ent review required- Y No
:anning
ldin
Applicant: 0/ Q 5�"�Lr 7")M &Zoning
Tree Administrator
Project: ATS 5 �' ,/ Public Works
Public Utilities
e Public Safety
Fine Services
F-0 _ De Signature F ��
Other Agency Review or Permit Required Review or Receipt ZQ1Q
of Permit Verified B
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: QT AApproved. ❑Denied.
(Circle one.) Comments:
BUiLDt
PLANNING&ZONING
Reviewed by: Date:3
TREE ADMIN. Second Review: ❑Approved as revised. QD ted_
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ElApproved as revised. (Denied.
Comments:
Reviewed by: Date:
Revised 05/14109