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Permit Folder 2101 Beach Ave a p4.01E(TICR FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION o Bureau of Beaches and Coastal Systems - 3900 Commonwealth Blvd--MS 300 Permit Number:FLO A ` � Tallahassee,FL 32399-3000 (850)488-7708 No,of PagesAttaehed: HELD PERMIT PURSUANT TO SECTION 161.053 or 161.052,FLORIDA STATUTES FINDINGS OF FACT AND CONCLUSIONS OF LAW: The request for a permit was considered by the staff designee of the Department of Environmental Protection and found to be in compliance with the requirements of Chapter 6213-33,Florida Administrative Code(FA.C.). Approval is specifically limited to the activity in the stated location and by the project description,approved plans(if any),attached standard conditions,and any special conditions stated below pursuant to Paragraph 161.053(5),Florida Statutes. This permit may be suspended or revoked in accordance with Section 62- 4.100,FAC. 1 PROJECT LOCATION 1 t , PROJECT DESCRIPTION:," � / f { 4 if ♦ r� i r .:. ' ,�=.. r is f.... !_.. � •'�v ..... .t;.., ... 1 z_ a ,' y.,.-, {' _ i SPECIAL PERMIT CONDITIONS: This permit is valid only after all applicable federal,state,and local permits aro obWnod and does not audwrize contravention of local setback requirements or zoning or building codes. This permit and public notice shall be posted on the site immediately upon issuance and shall remain posted along with local approval until the completion of any activity authorized by this permit. Other special conditions of this permit includei tE i r r _ P �i.4 f g <f STANDARD PERMIT CONDITIONS: The permittee shall comply with the attached standard fidd permit conditions. APPLICANT INFORMATION: I hereby certify that I sm either. (1a)the owner of the subject property or (1b)I have the owner's consent to secure this permit on the owner's bchalt and that(2)I shall obtain any applicable licenses or permits which may be required by federal,state,county,or municipal law prior to commencement of the authorized woriq (3)1 acknowledge that the authorized work is what I requested;and(4)I accept responsibility for compliance with all permit c onnd'' s. Alicant's Si g'natu �. r PP `� '` r°^"" Date Teleplrorre No D n?'•._ ... Applicant's Printed Name '- � r>' Address If applicant is an agent :. �:i_,' 'c"k r i ;A, _: fi<I �<' j_ n! y f( Lt �f - printed name of property owner property owner's addmar property owner's telephone no. DEPARTMENT FINAL ACTION AND FILING AND ACKNOWLEDGMENT: This field permit is approved on behalf of the Department of Environmental Protection by the undersigned staff designee,and filed on this date, pursuant to section 120.52,F.S.,with the undersigned designated Deputy Clerk,receipt of which is,lrereby ac"wled*. 1 �Staff DisigneelDepuly ClerkY l Printed N 'e of DesigneelDeprrty Clerk l -Doff' _ PUBLIC NdTICE IS ON THE BACK OF THIS PERMIT. EXPIRATION DATE: / {' (Emerspircy permits issued Pursuant to Section 6213-33.014,FA.C.,are valid for no more than ninety days and other permits valid fof no more thar),12 months. The staff designee may specify a shorter time brit.) EMERGENCY PERMIT:D YES NO Approval plans are attached: DYES ,. NO AND PUBLI6 NOTICE CONSPICUOUSLY ON THE SITE DEP form 73422(Updated 01/06) i'hue Copy-Tallahassee Office] [Yellow Copy Applicant] [Pink Copy-Staff Designee] ._ CITY OF ATLANTIC BEACH - _ FENCE PERMIT APPLICATION -- Date: PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION. Job Address: /�zl j 9 1 p4wcff d1/1-1, Owner's Name: 6e ("f i C��•'��/�'/f Address: �?_l d fl/F-fC14 Iye Phone: Legal Description: Block Number: Lot Number: 77 Zoning District: Fence Contractor: 'e-17 F"t Address: 4091- P� /`l�YT e/�T 1lp Phone: —49 3-'�O City:d 7-4, Ach( State: t- Zip: 3-"�V Fax: s %-4 Type offence and materials to be used: y)0 1 l G/< e r Valuation Of Fence: EBI'nterior Lot ❑Corner Lot �/�, ❑Dumpster or storage tank enclosure Is approval of Homeowner's Association or other private entity required? c V If yes,please submit with this application. Tree Protection: ❑NO. 11(pplicant certifies that no trees will be removed for the installation of this fence. ❑YES. Removal of Protected Trees will be required for this fence. TREE REMOVAL PERMIT IS REQUIRED. Tree Removal Permits to be reviewed by the Tree Conservation Board,which meets two times each month. Procedure: In order to expedite issuance of permits, please follow all steps and provide all information as appropriate. Incomplete applications may result in delay in issuance of permit. 1. Attach copy of property survey showing location, height and all distances from property lines of the proposed fence. (Fences shall not be placed within any utility or drainage easements without written permission from the Utility and/or Public Works Departments. Fences shall not restrict any private easement.) Address and contact information of person to receive all correspondence regarding this application(please print). Name: C Hf}ef^Td fi lee,<X Mailing Address: L / AFI}ChH /11 � - c Phone:'c 3`}''�if—�— �-�� Fax: / r .�3 7 7i E-Mail: CV/q(TSF a` -r Yffl' Ex vfey..�cmc 800 Seminole Road -Atlantic Beach,Florida 32233-5445 Phone: (904)247-5800 • Fax: (904)247-5845 - http://www.ei.atiantic-beach.fl.us Page I Revised 3/04104 a I hereby certify that I have read and examined this application and attached documentation and know the same to be true and correct. All provisions of the laws and ordinances governing this type of work will be complied with, whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any federal,state or local rules,regulations,ordinances,or laws in any manner, including the governing of construction or the performance of construction of the property. I understand that the issuance of this permit is contingent upon the above information being true and correct and that the plans and supporting data have been or shall be provided as required. Signature of Owner: Date:_7 f3 2,Q0 ! AS TO OWNER: Sworn to and subscribed before me this day of 20 4 State of Florida,County of Duval / /Q Notary's Signature: _ "V� �3k. WILLIAM L POPE ,� Personally known Notary PubliC, State Of Florida ❑ Produced identification My comm, eXp. OCt 19 2011 Type of identification produced Comm. No. DO 714ile Signature of Contractor: Date: etlo, AS TO CONTRACTOR: Sworn to and subscribed before me this X"Yy day of ,20 0/9. State of Florida,County of Duval Notary's Signature: WILLIAM L POPEPersonally known - Notary PublIC,State of Florida 4 Produced identification My comm, exp, Oct 19. 2011 Type of identification produced Comm. No. DO 714218 800 Seminole Road -Atlantic Beach,Florida 32233-5445 Page 2 Phone: (904)247-5800 - Fax: (904)247-5845 - http://www.ci.atiantic-beach.fl.us Revised 3/04/04 E�t��t4,OtECifCA' FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION EFLORZA Bureau of Beaches and Coastal Systems3900 Commonwealth Blvd--MS 300 Tallahassee, FL 32399-3000 Pamir Number., (850)4$$-770$ No.ofPagesAuached: FIELD PERMIT PURSUANT TO SECTION 161.053 or 161.052,FLORIDA STATUTES FINDINGS OF FACT AND CONCLUSIONS OF LAW: The request for a permit was considered by the staff designee of the Department of Environmental Protection and found to be in compliance with the requirements of Chapter 628-33,Florida Administrative Code(FA.C.). Approval is specifically limited to the activity in the stated location and by the project description,approved plans(if any),attached standard conditions,and any special conditions stated below pursuant to Paragraph 161.053(5),Florida Statutes. This permit may be suspended or revoked in accordance with Section 62- 4.100,FA.C. ? f ! y i PROJECT LOCATION - ' t . ; PROJECT DESCRIPTION: r l ' c, r SPECIAL PERMIT CONDITIONS: This permit is valid only after all applicable federal,state,and local permits are obtained and does not authorize contravention of local setback requirements or zoning or building codes. This permit and public notice shall be posted on the site immediately upon issuance and shall remain posted along with local approval until the completion of any activity authorized by this permit Other special conditions of this permit include; x ' f f t i ✓ Z � r, - --r STANDARD PERMIT CONDITIONS: The permittee shall comply with the attached standard field permit conditions. APPLICANT INFORMATION: I hereby certify that I am either: (Ia)the owner of the subject property os (lb)I have the owner's consent to weum this permit on the owner's bdaalt and that(2)I shall obtain any applicable licenses or permits which may be required by federal,state,county,or municipal law prior to corturAmeement of the authoized work; (3)I acknowledge that the authorized work is what I requested;and(4)I accept responsibility for compliance with all pemut coeds / Applicant's Signature •— `��,.-�`' _Date 7%1 Telephone No nt' � Applicas Printed Name I� {' ''' ,+" '" ' Address w If applicant is an agent: (_./ r i > �c�. , ,� t , c, -„jr�t''�'c�,, vat Y� [ C� t` � �i�'1'”Y117 printed nacre of property owner property owner's addrear property ow nirr's telephone no. DEPARTMENT FINAL ACTION AND FILING AND ACKNOWLEDGMENT: This field permit is approved on behalf of the Department of Environmental Protection by the undersigned staff designee,and filed on this date, pursuant to section 120.52,F.S.,with the undersigned designated Deputy Clerk,receipt of which is.6ereby ackpowkd*d. r r' t t 1 tall Dtsignee/Deputy Clerk Printed N�arne of Designee Deputy Clip* Daly PUBLIC NOTICE IS ON THE BACK OF THIS PERMIT. EXPIRATION DATE. (E permits issued ppuursuant to Section 62B-33.014,FA.C.,aro valid for no more than ninety days and o er pemuts v no more than-�nths. The staff designee may specify a shorter time 'mit.) EMERGENCY PERMIT:0 YES T+1 NO Approved plans are attached: LDVES NO AND PUBLI&NOTICE CONSPICUOUSLY ON THE SITE DEP form 73422(Updated 01/06) VhiteCopy-Tallahassee Office] (Yellow Copy Applicant] [Pink Copy-StaffDesignee] SS CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 09-00001032 Date 2/19/10 Property Address . . . . . . 2101 BEACH AVE Application type description FENCE PERMIT Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 ---------------------------------------------------------------------------- Application desc Oft fence ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ PERERA, CHARITH GENESIS BUILDING CORP 2101 BEACH AVENUE 2158 MAYPORT RD. ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 (904) 241-0320 ---------------------------------------------------------------------------- Permit . . . . . . FENCE PERMIT Additional desc . . Permit Fee . . . . 35 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Expiration Date . . 8/18/10 ---------------------------------------------------------------------------- Special Notes and Comments *ALL FENCES OR ENCLOSURES OF LAND SHALL BE SUBSTANTIALLY CONSTRUCTED. *SCHEDULE FINAL INSPECTION ONCE FENCE HAS BEEN COMPLETED. PERMIT AND APPROVED SURVEY MUST BE AVAILABLE FOR FINAL INSPECTION. ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 35 . 00 35 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 35 . 00 35 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. CITY OF ATLANTIC BEACH FENCE PERMIT APPLICATION Date: PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION. Job Address: /�719 ,%� Owner's Name: T ey� li i �/��✓��l 7�1f Address: �l d( 13)-fC4 ,•lVe Phone: Legal Description: Block Number: Lot Number:_7 Zoning District: Fence Contractor: 447fi,f/e1W iq46V. C041-191 Address: a� i`1 YP�'T / 11� Phone: City:z7_4, State: f::- t- Zip: 3 Fax: 0 3 Type of fence and materials to be used: ut�o o eL c-l< e-r- Valuation Of Fence: �OD, C)p ETI'nterior Lot ❑ Comer Lot ❑Dumpster or storage tank enclosure Is approval of Homeowner's Association or other private entity required? ty t/ If yes,please submit with this application. Tree Protection: ❑NO. ►Applicant certifies that no trees will be removed for the installation of this fence. ❑ YES. Removal of Protected Trees will be required for this fence. TREE REMOVAL PERMIT IS REQUIRED. Tree Removal Permits to be reviewed by the Tree Conservation Board,which meets two times each month. Procedure: In order to expedite issuance of permits, please follow all steps and provide all information as appropriate. Incomplete applications may result in delay in issuance of permit. 1. Attach copy of property survey showing location, height and all distances from property lines of the proposed fence. (Fences shall not be placed within any utility or drainage easements without written permission from the Utility and/or Public Works Departments. Fences shall not restrict any private easement.) Address and contact information of person to receive all correspondence regarding this application(please print). Name: C 1,4e(" -�( c� e2 lee✓� Mailing Address: L Phone: Fax: r � lG4- - JOC. E-Mail: ,�Hyl 800 Seminole Road •Atlantic Beach,Florida 32233-5445 Phone: (904)247-5800 • Fax: (904)247-5845 • http://www.ei.atiantic-beach.fl.us Page l Revised 3/04/04 I hereby certify that I have read and examined this application and attached documentation and know the same to be true and correct. All provisions of the laws and ordinances governing this type of work will be complied with, whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any federal,state or local rules,regulations,ordinances,or laws in any manner, including the governing of construction or the performance of construction of the property. I understand that the issuance of this permit is contingent upon the above information being true and correct and that the plans and supporting data have been or shall be provided as required. Signature of Owner: Date: AS TO OWNER: Sworn to and subscribed before me this e day of �� 200/. State of Florida,County of Duval Notary's Signature: WILLIAM L POPE JAC57.1i Personally known Notary Public, State of Florida ❑ Produced identification My comm, eXp. OCt 19, 2011 Type of identification produced Comm. No. DO 714216 Signature of Contractor: Date: AS TO CONTRACTOR: c Sworn to and subscribed before me this day of ,20 6)f. State of Florida,County of Duval / r Notary's Signature: -�t✓. � �� �� WILLIAM L POPE Wr Personally known Notary Public, State of Florida Produced identification My comm, eXp, OCt 19, 2011 Type of identification produced Comm. No. DO 714216 800 Seminole Road •Atlantic Beach,Florida 32233-5445 Phone: (904)247-5800 Fax: (904)247-5845 - http://www.ci.atiantic-beach.fl.us Page 2 Revised 3/04/04 FBot;(TiO4 FLORIDA DEPARTMENT OF ENVIRONM NTAL PROTECTION o, Bureau of Beaches and Coastal Systems � 3900 Commonwealth Blvd -MS 300 Permit Number: W FLQRI Tallahassee,FL 32399-3000 (850)488-7708 No.of PagesAaached: FIELD PERMIT PURSUANT TO SECTION 161.053 or 161.052,FLORIDA STATUTES FINDINGS OF FACT AND CONCLUSIONS OF LAW: The request for a permit was considered by the staff designee of the Department of Environmental Protection and found to be in compliance with the requirements of Chapter 628-33,Florida Administrative Code(F-A.C.). Approval is specifically limited to the activity in the stated location and by the project description,approved plans(if any),attached standard conditions,and any special conditions stated below pursuant to Paragraph 161.053(5),Florida Statutes. This permit may be suspended or revoked in accordance with Section 62- 4.100,F.A.C. PROJECT LOCATION - PROJECT DESCRIPTION: ti SPECIAL PERMTT CONDITIONS: This permit is valid only after all applicable federal,state,and local permits are obtained and does not authorize contravention of local setback requirements or zoning or building corks. This permit and public notice shall be posted on the site im ediatelly upon issuance and shall remain posted along with local approval until the completion of any activity authorized by this permit Other special conditions of this permit include; r , STANDARD PERMIT CONDITIONS: The pennittee shall comply with the attached standard field permit conditions. APPLICANT INFORMATION: I hereby certify that I am either: (la)the owner of the subject property gf (lb)I have the owner's consent to secure this permit on the owner's behalL and that(2)I shall obtain any applicable licenses or permits which may be required by federal,state,county,or municipal law prior to comrnencement of the authorized work, (3)I acknowledge that the authorized work is what I requested;and(4)I accept responsibility for compliance with all permit conditions �f Applicant's Signature � f Date � Telephone No.( ) �._ Applicant's Printed Nance % � +i' Address - -' If applicant is an agent: printed name of property owner property owner's address properly owner's telephone no. DEPARTMENT FINAL ACTION AND FILING AND ACKNOWLEDGMENT: This field permit is approved on behalf of the Department of Environmental Protection by the undersigned staff'designee,and filed on this date, pursuant to section 120.52,F.S.,with the undersigned designated Deputy Clerk.receipt of which is hereby acknowk 1ged. ,Staff DesigneelDeputy Clerk Printed Naive ofDesigned£kputy Clerkf Date PUBLIC NOTICE IS ON THE RACK OF THIS PERMIT. EXPIRATION DATE: (emergency permits issued pursuant to Section 6213-33.014,FA.C.,we valid for no more than ninety days and other r permits writ valid for no more tfan 12 months. The staff designee may specify a shorter time limit.) EW GENCY PIT- J.1T:0 YES NO Approved plans are attached: ❑YES 0 NO AND PUBLIC,NOTICE CONSPICUOUSLY ON THE SITE DBP form 71-122(Updated 01(06) Price Copy-Tallahassee Office] [Yellow Copy-Applicant] [Pink Copy,Sta Eiesignee] Public Utilities Plan Review Comments Date: -7 l 161 D� Initials• Project blame/Address: �I 0W% Ave Application Permit#: 1 D 3' Check Box Application Tracking Comments to Add Comment Avoid damage to underground water/sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is needed, call ❑ 247-5834. Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and ❑ visible. A sewer cleanout must be installed at the property line. Cleanout must be covered ❑ with an RTl concrete box with metal lid. Cleanout to be set to grade and visible. A reduced pressure zone backflow preventer must be installed if irrigation will be provided or if there is a private well on the property. Backflow preventer must be ❑ tested by a certified tester and a copy of the results sent to Public Utilities. Plans note the building will be unsprinkled. If plans change, any fire line installed must be metered with a Sensus touch-read meter in a properly sized vault and an ❑ appropriate backflow preventer installed. Backflow preventer must be tested by a certified tester and a copy of the results sent to Public Utilities. If fire sprinkler system is provided, contact Malcolm Clemons at 247-5839 for backflow requirements. At a minimum,will require double check backflow ❑ preventer. Fire lines must be metered with a Sensus touch-read meter. Meters larger than 2" ❑ must be installed in a vault as noted in JEA specifications. CITY OF ATLANTIC BEACH FENCE PERMIT APPLICATION Date: PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION. Job Address: 1�2,1 Owner's Name: ( C� creli Address: Phone: Legal Description: Block Number: Lot Number: 77 Zoning District: —G Fence Contractor: Address. a"Zl)� i`1 Yr✓/?T / 1s' Phone: City:_zI T4- 'C.H State: Zip: 3 Fax: Type offence and materials to be used: x/ou Valuation Of Fence: ©y dy 1 Interior Lot ❑ Comer Lot ❑Dumpster or storage tank enclosure Is approval of Homeowner's Association or other private entity required? iy t/ If yes,please submit with this application. Tree Protection: ❑NO. ►Applicant certifies that no trees will be removed for the installation of this fence. ❑YES. Removal of Protected Trees will be required for this fence. TREE REMOVAL PERMIT IS REQUIRED. Tree Removal Permits to be reviewed by the Tree Conservation Board,which meets two times each month. Procedure: In order to expedite issuance of permits, please follow all steps and provide all information as appropriate. Incomplete applications may result in delay in issuance of permit. 1. Attach copy of property survey showing location, height and all distances from property lines of the proposed fence. (Fences shall not be placed within any utility or drainage easements without written permission from the Utility and/or Public Works Departments. Fences shall not restrict any private easement.) Address and contact information of person to receive all correspondence regarding this application(please print). Name: C/O ,py lee✓� Mailing Address: J to / Phone: /�L 'L, �-�— ��z� Fax: IG' W-3 - 7 7cV E-Mail: r 800 Seminole Road •Atlantic Beach,Florida 32233-5445 Phone: (904)247-5800 • Fax: (904)247-5845 • http://www.ci.atiantic-beach.1l.us Page l Revised 3/04/04 I hereby certify that I have read and examined this application and attached documentation and know the same to be true and correct. All provisions of the laws and ordinances governing this type of work will be complied with, whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any federal, state or local rules,regulations,ordinances,or laws in any manner,including the governing of construction or the performance of construction of the property. I understand that the issuance of this permit is contingent upon the above information being true and correct and that the plans and supporting data have been or shall be provided as required. Signature of Owner: Date: 7 I f 3 12-y 0 AS TO OWNER: Sworn to and subscribed before me this day of 20—,� State of Florida, County of Duval Notary's Signature: Vx& �`f WILLIAM L POPE Z Personally known Notary Public, State of Florida ❑ Produced identification My comm. exp. Oct 19, 2011 Type of identification produced Comm. No, DO 714216 Signature of Contractor: Date: PIC T, AS TO CONTRACTOR: Sworn to and subscribed before me this �p day of lie, 20 ,07 State of Florida,County of Duval / r Notary's Signature: WILLIAM L POPEPersonally known Notary Public, State Of Florida 4M Produced identification My comm, expDD 714218, OCt 19, 2011 Type of identification produced Comm. No. 800 Seminole Road -Atlantic Beach,Florida 32233-5445 Page 2 Phone: (904)247-5800 Fax: (904)247-5845 - http://www.ei.atlantic-beach.fl.us Revised 3/04/04 FR'v?.C1iVk �` FLORIDA DEPARTMENT OF ENVIRON119LNTAL PKOTECTION Cry�J~ a Bureau of Beaches and Coastal Systems } 1900 Commonwealth Blvd-- MS 300 pf nit Number: W fLORTDA` Tallahassee,FL 32399-3000 (850)488-7708 No. of PagesAltaclled: FIELD PERMIT PURSUANT TO SECTION 161.053 or 161.052,FLORIDA STATUTES FINDINGS OF FACT AND CONCLUSIONS OF LAW: The request for a permit was considered by the staff designee of the Department of Environmental Protection and found to be in compliance with the requirements of Chapter 6213-33,Florida Administrative Code(FA.C.). Approval is specifically limited to the activity in the stated location and by the project description,approved plans(if any),attached standard conditions,and any special conditions stated below pursuant to Paragraph 161.053(5),Florida Statutes. This permit may be suspended or revoked in accordance with Section 62- 4.100,F.A.C. PROJECT LOCATION. i' PROJECT DESCRIPTION: ` SPECIAL PERMIT CONDITIONS: This permit is valid only atter all applicable federal,state,and local permits are obtained and does not authorize contravention of local setback requirements or zoning or building codes. This permit and public notice shall be posted on the site immediately upon issuance and shall remain posted along with local approval until the completion of any activity authorized by this permit. Other special conditions of this permit include; ^r a , t, t, STANDARD PERMIT CONDITIONS: The permittee shall comply with the attached standard field permit conditions. APPLICANT INFORMATION: I hereby certify that I am either: (la)the owner of the subject property 21 (1b)I have the owner's consent to secure this permit on the ownces behalf;and that(2)I shall obtain any applicable licenses or permits which may be required by federal,state,county,or municipal law prior to commencement of the authorized work-, (3)I acknowledge that the authorized work is what I requested;and(4)I accept responsibility for compliance with all permit conditions. ; r Applicants Signature Date f Telephone No.( ) f; Applicants Printed Name ; Address If applicant is an agent:, ( .. f., _ .r`.' r t ,. ;. �•.... ,�/f i'p.r_ i� Y i., t f'.`f ,� ; -.f)t°` ':-..;�„i 1 printed name of property owner properly owner's address property owner's telephone no. DEPARTMENT FINAL ACTION AND FILING AND ACKNOWLEDGMENT: This field permit is approved on behalf of the Department of Environmental Protection by the undersigned staff'designee, and filed on this date, pursuant to section 120.52,F.S.,with the undersigned designated Deputy Cleric,receipt of which is,hereby acknowledged. ,Stafj'`DesigneelDepaty Clerk Printed Naive of Desi,grie6 Deputy ClerkDote PUBLIC NOTICE IS ON THE BACK OF THIS PERMIT. EXPIRATION DATE: (E ergtney perrnits issued pursuant to Section 62B-33.014,FA.C.,arc valid for no more than ninety days and other ► permits i)r`e v no more than 12 months. The staff designee may specify a shorter time limit.) EMERGENCY PERMIT:0 YES 11, NO Approved plants arc attached: BYES ONO AND PUBLIC NOTICE CONSPICUOUSLY ON THE SITE DEP forma 73-122(Updated 01/06) Flt teCopy-Tallahassee Office] [Yellow CopyApplicanlj /Pink Copy-smffDesignee] City of Atlantic Beach APPLICATION NUMBER 2 Building Department (To be assigned by the Building Department.) j s 800 Seminole RoadQd 2- anceac , ora 32233-5445 Phone (904)247-5826 • Fax(904)247-5845 Q E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: C;?/0 / '31q C PDapartment review required Yes No Applicant: WfAS d annin & g Tre inistrator Project: `t' 71 /, ' is Public Safety Fire Services Review feeSignatures . Other Agency Review or Permit Required Review or Receipt Date 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: V24proved. ❑Denied. (Circle one.) Comments: BUILDING ELANNING Reviewed bY: Date: 17'16 �� 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 City of Atlantic Beach .o APPLICATION NUMBER Building Department (To be assigned by the Building Department.) r 800 Seminole Road 6 2009 Z. J Atlantic Beach,Florida 32233-5445 Phone(904)247-5826 • Fax(904) F5 E-mail: building-dept@coab.us Date routed: 4 City web-site: http:Nwww.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: C?/&4 ���fry D ent review required Yes No Applicant: �5 d ann & g Tre inistrator ii Project: i is Public Safety Fire Services Review fee $ ,. Dept Signature Review or Receipt Date Other Agency Review or Permit Required 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: NApproved. ❑Denied. (Circle one.) Comments: BUILDING / PLANNING &ZONING �.--� Reviewed by: Date: / 70 TREE ADMIN. Second Review: ElApproved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: QApproved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 City of Atlantic Beach APPLICATION NUMBER Building Department 4UL 6 2009 (To be assigned by the Building Department.) r 800 Seminole Road (� 2 Z '' =r Atlantic Beach, Florida 32233-5445 d Phone(904)247-5826 • Fax(904) - O E-mail: building-dept@coab.us Date routed: City web-site: http://www.mab.us APPLICATION REVIEW AND TRACKING FORM Property Address: C�/4 / 117 C A Af, Department review required Yes No Applicant: d annin & g Tre inistrator Project: 71 Oubtin Ul" ' Public Safety Fire Services Review fee $ Y .. Dept Signature Other Agency Review or Permit Required Review or Receipt Date 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: Approved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: 7 TREE ADMIN. Second Review: QApproved as revised. ❑Denied. PUB WORK Comments: UB L C U I I PUBLI AFETY Reviewed by: Date: FIRE SERVICES Third Review: [Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 City of Atlantic Beach APPLICATION NUMBER Building Department (ro be assigned by the Building Department.) r 800 Seminole Road Q Atlantic Beach, Florida 32233-5445 d 2 Phone(904)247-5826 • Fax(904)247-5845 D E-mail: building-dept@coab.us Date routed: City web-site: http://v~.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 0?/4 / .3-0q C Qepa4ment review required Yes No Applicant: .,5 annin &ZoRdg Tre inistrator Project: 71 /, i cp�is Public Safety Fire Services Review fee-$. Dept Signature Other Agency Review or Permit Required Review or Receipt Date of P rmit 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: Approved. ❑Denied. (Circle one.) 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