Permits 738 Aquatic Drive CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
V&
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 08-00001136 Date 8/19/08
Property Address . . . . . . 738 AQUATIC DR
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
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Application desc
RE-PIPE FOR 16 FIXTURES
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Owner Contractor
------------------------ ------------------------
CALLENDER, ANGELA PLUMB-PAL, INC.
738 AQUATIC DRIVE 1728 SABLE PALM LANE
ATLANTIC BEACH FL 32233 JAX BEACH FL 32250
(904) 246-8856
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Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Permit Fee . . . . 147 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 2/15/09
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Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 147 . 00 147 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Grand Total 147 . 00 147 . 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
800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 08 LJ
OFFICE:(904)247-5826 0 FAX NO.:(904)247-5845
BUILDING-DEPT@C0AB-US
PLUMBING PERMIT
APPLICATION DUVAL COUNTY
11177,7777,77-7 77 7 3."DATE..
1.JOB ADDRESF'.
0
OYES PERMIT#:-
3
PROPEUM 0 NER:
FERENT FROM JOB ADDRESS: 6.PHONE:
4.NAME: 5.ADDRESS IF DIF
o ,J.4 -7-3 /4 Q-
PLUMBING CONTRACTOW',`!�'�'e'
B.ADDRESS.:
7.NAME OF COMPANY:
et,11/" 6 -
9.STATE OF FLORIDA LICENSE NO: 10.CELL PHONE: 11.FAX NO.:
r— - 14.
12.EMAIL ADDRESS: 13.OFFICE PHONE:
441 Q
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that all work will be performed to meet the
standards of all laws regulating construction in 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.
CONTRACTORS SIGNATURE:
:TCODE
16. 18L CURTISNITCOD
15.NATURE OF WOFW1 [3'06 FLORIDA BUILDING CODE-
0 N�W PLUMBING
QAE-PIPE 13 OTHER:
',.:19.'NUMBER'OFrFIXTUU
BATH TUB SEWER CONNECTION
BIDET -Z- SHOWERS
DISH WASHER SHOWERS PANS
DISPOSAL SINK
DRINKING FOUNTAIN WATER CLOSET TANK
FLOOR DRAIN WATER CLOSET VALVE
HOSE BIB WASHING MACHINES
ICE MAKER WATER CONNECTION
INTERCEPTOR WATER HEATER
Z- LAVATORY URINALS
LAUNDRY TRAY OTHER(SPECIFY):
ROOF DRAIN
20.PLUMBING PERMIT FEES:
PERMIT ISSUING FEE: $35.00
TOTAL FIXTURES: X $7.00 (PER FIXTURE) + $35.00
COAB FORM BLDG03:REVISED:1/10/2008
CITY OF ATLANTIC BEACH
DEPARTMENT OF BUILDING
800 Seminole Road -Atlantic Beach, F1 32233 - Tel. (904) 247-5826
ROOFING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: . .24563 Address: 738 AQUATIC DRIVE
Permit Type: RE-ROOF ATLANTIC BEACH, FL 32233
Class of Work: NEW Township: Range: Book:
Proposed Use: SINGLE FAMILY
Lot(s): Block: Section:
Square Feet: Subdivision: AQUATIC GARDENS
Est. Value: Parcel Number:
Improv.'Cost: 1,700.00 OWNER INFORMATION
Date Issued: 7/3112002 Name: BROWN,'DUNCAN
Total Fees:' 30.OQ Address: 738 AQUATIC DRIVE
Amount Paid: 30.00 ATLANTIC BEACH, FL 32233
Date Paid: 7/31/2002 :
Phone: __(904)24970148 '
Work Desc: RE-R-OOF
CONTRAnTnR(S) 'ATION FEES
R. D. WOODS ROOFING
30.00
'47
...........
&gal
40
N,
]ON
BUILDING MATERIAL,��
MUST BE I CLEARED�U SPACE,,AND
FAILURE TO GOMPL THE
PROPERTY OWNER P
..........
ISSUED ACCORDING TO.APPRO/E SUBJECT TO REVOCATION.
FOR VIOLATION OF.APPLICABLE PRO.
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City of Atlantic Beach 800 Suninole Road Atlantic Beach. Florida 32233-5445
Phone: (904) 247-5800 FAX (904) 247-5SO5 0 http://www,/ci.atJantic-beacii.tl.us
PERA11T APPLIC.ATION FOR R00F1_N(;
JOB LOCATION fe
OWNER OF P ERTY;I
R PHONE 4 ?L
CONTRACTOR
CONTRACTOR ADDRESS,L�o
CONTRACTORS LICENSE NO, PHONE
SCOPE OF WORK
DECK SLOPE GREATERTHAN2 12 LESS THAN 2 : 12 ACTUAL
VALUATION OF WORK S
PRODUCT NAME & MATERIAL
TO BE USED
2-6— ASTM DESICYNATIQN(,S)--3-2—&/—aLj-f, ca-
REQUIR-Ff) INSPECTIONS SHEATHING F I-NA L
LIBILITY LNSURANCE PO.LICYSUppLLpD --,/
--NO
WOR-KE,RS COM-P. POLICY SUPPLIED YES NO
CONTRACTOR LICENSE SUPPLIED YES NO
OCCUPATIONAL LICENSE SUPPLIED NO
SIGNATURE OF OWNER
SIGNATURE OF CONTRACTOR
SWORNTO & SUBSCRIBED BEFORE ME, TFCS OAY OF _200
AS TO OWNER NOTARY PUBLIC
AS TO CONTRACTOR NOTARY Puj3LIC
PAIRCUMAHU
MY COMMISSIO14#CC 90260
EXPIRES:Decefter it,20
Bonded Thru Notary Pubk Undo
CltrY OF ATLANTIC BEACH PERMIT CALCULATION SHEET
Address 43R .1-7qq
t. !30 .
Date
Heated Square Footage @ b��- -.per sq f t = $
Garage/Shed &
@ $ per sq ft = $
Carport/Porch \,W--@ per sq ft = $ _
Deck A), $_per sq ft = $
V
Patio @ $_per sq ft = $
TOTAL VALUATION: $
- 00
10 0 t C\- $
Total Valuation 1st $ 1 wee,
7EQ,00 %6
Remaining Value per thousand
or portion thereof
TOTAL BUILDING FEE $- O;D
+ 1/2 Filing Fee $ 1007
( ) Fireplaces @ $15 . 00 $
BUILDING PERMIT FEE $ 0 C)
WATER IMPACT FEE $
SEWER IMPACT FEE $
WATER METER/TAP
CAPITAL IMPROVEMENT $
SEWER TAP $
RADON (HRS) . 0050
SECTION H PAVING $
HYDRAULIC SHARES $
CROSS CONNECTION
) SURCHARGE . 0050 $
OTHER $
GRAND TOTAL DUE $ 80.
ADDITIONAL PERMITS OR FEES : Mechanical_; Plumbing
Electric/New Electric/Temp_; SwimmingPool
Septic Tank Well_; Sign_Finish Floor Elevation
Survey Other
CALCULATIONS and/or NOTES :
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5826
Application Number . . . . . 09-00000974 Date 7/07/09
Property Address . . . . . . 738 AQUATIC DR
Application type description RESIDENTIAL OTHER
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 1675--------------- --------------
-- -------------------------------------------
Application desc
replace siding t1-11 -------------------------------
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Contractor
owner ------------------------
------------------------ FLINT CONSTRUCTION SERVICES
CALLENDER, ANGELA 1419 LINKSIDE DRIVE
738 AQUATIC DRIVE FL 32233 ATLANTIC BEACH FL 32233
ATLANTIC BEACH (904)
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Permit . . . . . . BUILDING PERMIT
Additional desc . - 40 - 00 Plan Check Fee 20 . 00
Permit Fee . . . . Valuation . . . . 1675
Issue Date . . . .
Expiration Date . - 1/03/10 - ------------------------------
- -------- ---------------------------------
Special Notes and Comments
*2007 FLORIDA BUILDING CODE w/ , o5- 106 SUPPLEMENTS .
2007 FLORIDA BUILDING CODE - RESIDENTIAL.
2005 NATIONAL ELECTRICAL CODE.
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE To THE BUILDING
DEPARTMENT IMMEDIATELY. --------------- -------
- --------------------------------------------------
Fee summary Charged Paid Credited- Due---
----------------- ---------- ---- -------- ---
Permit Fee Total 40 - 00 40 . 00 . 00 . 00
Plan Check Total 20 . 00 20 . 00 . 00 . 00
Grand Total 60 - 00 60 - 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
y EA
CIT OF ATLANTIC B CH
800 SEMINOLE ROAD,ATLANTIC BEACH,FL 32233 09
OFFICE:(904)247-5826 0 FAX NO.:(904)247-5845
BUILOING-DEPT@COAB,US
BUILDING PERMIT APPLICATION DUVAL COUNTY
1.JOB ADDRESS: 2.VALUATION OF WORK 11$Q.FT.UNDER ROOF
7:71 1
4.LEGAL DESCRIF rl S.CL�Ass S.USE OF STRUCTURE:
13 NEW BUILDING 0 DEMOLITION 0 RESIDENTIAL
LOT_BLOCK_SUB DIVISION 13 ADDITION 0 CONVERTING USE E3 COMMERCIAL
7.DESCRIPTION OF WORK 11 ALTERATION
e- 0 ACCESSORY BLDG. 8.FIRE SPRINKLER:
11 REPAIR 0 POOL/SPA 11YES 13N-1A
-�r 11 MOVE 0 OTHER 0 NO
PROPERTY OVIINER: CONTRACTOR: AREHITIE11 I ENGINEER:
9.NAME: ne 15,COMPAVY NAME- 23.COMPANY NAME:
IpIko, F k,f ,J. -�t'
-6;�P 0-1 --"
16.NAME: ecse /I c(i�f 24.LICENSEE NAME:
10.ADDRESS: 17.STATE OF FLORIDA LICENSE NO.- 1<-dr 25.STATE OF FLORIDA LICENSE NO.:
(AA-r.'LDe- 18.ADDRESS: 4 (6( 26.ADDRESS:
3AM
11,OFFICEPHONE: _ TFAX NO,: 19.OFFICE PHONE 120.FAX NO.: 27.OFFICE PHONE: 28.FAX NO.:
369-0.ff,�- qo 4 f 4(" f(#,;L(A I v4 1;7; '?o e( 1
13.CELL PHONE:- 21.CELL PHONE: 29.CELL PHONE:
JZ61—9?�Le 10
14.EMAIL ADDRESS* 22.EMAIL ADDRE S' 30.EMAIL ADDRESS:
FEE SIMPLE IME HOILDER:'
OF OTHER THAN OWNER) 13ONDING COMPANY- MORTGAGE LENDER:
31.NAME, 33.NAME: 35.NAME:
32-ADDRESS: 34.ADDRESS: 36.ADDRESS:
Application 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 all laws regulating construction in 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. I understand that separate permits must be secured for
Electrical Work,-Plumbing,Signs,Wells,Pools,Furnaces,Boilers,Heaters,Tanks, Air Conditioners,etc.
OWNEWS AFFIDAVIT-I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable
laws regulating construction and zoning.I 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 official,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 BEFORE THE
FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR
LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
OWNER or AGENT CONIII(AC—TOR
AI1A9snIJPOVrFf)6may OrAgwlq Letter Required)
Signed7 CA!11��� Date: 071 F 67101 --Signed: (Qualifier Q*)
Before Via day ; // 4�A ;��—Date:
2009 in the county of Before me this :7 0 day of —,2009 in the county of
Duval,State of FlIa,has rsonal" peared Duval,State of Flodda,has personally ap��aired
,+1—+-7% L&'?Z'J ix
se
herin by himself i rilt that all statements anddebarations are herin by himself I herself and affirms that all statements and declarations are
true an Ei rate. true and accurat
Notary a,State of ounty Of Not
'"Public at Large,State of rl6k-ounty of
0 Personally fTPersonally Known
Produced Cabo 11 11 Produced Identification
It n iNota
AWAM ry Signature:
Nota '��Fllodda
StWlaie�Floldda
ry P
:My Commission Exf WMAD UBLIC-S7ATE OF FIORMA
Commission 4 Brook�! McGoye
D ii,�PPI&Ogig-IM0 D FOR CODE COM Commission#DD717436
Expires: NOV 04,2011
OFATLANTIC B ED RU
'D
SEE PERMITS FOR ADDITIONAL 2ONDF
REQUIREMENTS AND CONDITIONS.
BY."
l[=REVIEWED DATE: copy
L=
TYPE OF IMPROVEMENT _ PROPOSED USE
•AccesW Building E3 Mobile Home Parka #of Units �SIDENTIA[ Units
•Addibor� E�3�N Building 0 Apartments 0 Amusement Recreational
0 Alterations and Repairs No buctural Sicling law box below)* E3 Carport 0 Business Condo
0 Converting Use 0 Other Specify 01rondominium. 0 Church,other Religious
[3 Dernolition [3 RV Parka&Camps 13 Duplex [3 Dayeare
0 Foundation Only 0 Shelf Building 0 Garage 0 Hospital,Institutional
13 Mom Building into Duval County 0 SWrouning Pool(in ground)—Gallons_ 13 Othw:Specify C3 Hotel,Motel,Dormitory
E3 Move Buildrig out of Duval county 0 SIMmming P"(Above Ground)—Gallons_ E3 Single Family [3 Industrial
C3 Move Buildrig within Duval County [3 Tenant Build-out 0 Townhouse, 0 Office,Bank Professional
[3 Windows I Door Replacement 0 3 or 4 Families E3 Other.Specify_
If you selected Non-structural Siding then k the"of siding matenaw— E3 Parking Garage
13 Aluminum 0 ciamentuous, [3 vinyl [3 Restaurant
;r.. E3 Other:Specify 0 School,Library,Educational
Nature of Work*[3 Soffit [3 Fascia ar""Siding 13 Service Station,Repair Garage
Master Product Approval Number 0 Stores,Mercantile
Utilities
DIMENSIONS WATER SUPPLY SEWAGE DISPOSAL PRINCIPLE TYPE OF NEW RESIDENTIAL
Number of Shin. Wfutilic-City, 0 P blic-City FRAME PERMIT INFO
13 Masonry(Load searing) Single Family
Building Haight IC fast [3 Private Utility Company E3 Pumb,Ullfty Company eWood Frarn. No of Bedrooms
Total Floi(SF) 13 Private Wall [3 Pnmte Sept. 0 Structural Steel Bathrooms
Endosed Too WHICH BUILDING 0 Reinforced Concrete Full
Unenclosed S.I.C.CODE CODE WAS USED FOR
PROJECT? 0 Other Specify Partial
New Land Anai— Multi-Family
0 square feet 0 acres
1- Ona-bedroorn units
Impervious Area Added For This Permit For demolition I renom on projects involvi ng a commercial,institutional or
oiiqft�0iii MECHANICAL industrial structure or apartment building of more than four dwelling units,the
following provisions a.applicable T—td,..m unit.
Altered Fioor/Story
HVAC 0 Yes 0 N. 1.Renovation:Is asbestos present? 0 Yes 0 No
Altered Floor Area(SF) != ion:If asbestos is subsequently discovered,then the abbce, Three-plus bodroom units
Enclosed Total Cooling Capacity sly provide notice to the DER and AQD and amend thin
appli..b.n.
Unenclosed
Fire Sprinklers 0 Yes[3 No IL Demolition:All applicants must pnord.Notice to DER and ACD
regardless of whether asbestos is present.
CERTIFICATE OF Occupancy Classification: Occupancy Load: Live Loads: Florida Building Code
OCCUPANCY: Type of Construction:
MOVING A HOUSE OR BUILDING
AdIdirews Moving From Address Mewing To
Number—Street TYPO—Director, Number_Street Type_Direction
Loaded Size of Building:Width_Height_Length Loaded Swe of Building Width—Height_Length_
Travel Route Travel Route
Notes Not.
OFFICIAL USE ONLY
PERMIT REQUIREMENTS FEE CALCULATIONS_ AREA(S—F)—F FEES
1. Submit two sets of shop drawings for Enclosed Divided Am.
and secure approval prior to erection. 1�thru 4"Floors
2. No landscape required. Above 4'Floor
3. Initial and Final Elevation Certificates required—Submit to Development Services, Enclosed Undivided Area
Room 2100,214 North Hogan Street Unenclosed Area
V Submit Initial Certificate prior to inspection requests for work completed above the slab.
-1 Submit Final Certificate prior to request for building final inspection,
4, 0 Call 63G-49GO for NPDES inspection prior to commencement of site work.
5. TOTALFEE
STATE SURCHARGE (SF)
APPROVAL NOTES&REQUIRED INSPECTIONS
DEVELOPMENT MANAGEMENT GROUP FIRE MARSHALL BUILDING
Interior Only No Exceptions 0 02 OP Fnd [3 22 Red WI 0 W VA Shtg
0 08 Ftg [3 23 R!Shtg [3 59 F1 Call
Exceptions as Noted 0 09 Final 0 34 ADA 0 61 Set Off
Office of the City Engineer Sheet# 0 1:Tie Bm [3 46 Lathe 0 62 Elv Fit Wk
BFE 0 1 Fosene 13 40 Crtn M E3 63 RfW Slit
FZ—No Date--J--J—Signed 0 9 Insi 0 49 Thresh 0 64 Dy4.
C3 20 Slab 0 S2 Pria-Drinc,
Date—/--J_Signed 46 [3 21 S—Pf E3 57 Op.FI F,
LANDSCAPE 01--ftw) 0 03 [1 17 ELEC— MECH PLBG
AIR QUALITY
HEALTH OFFICIAL CONCURRENCY MANAGEMENT
D—nimis By_Data
Fair Share
PLANNING JEDC Override
Approval Exempt —By—Date
JEDC Final Required VPAC I CRC NO.
Revised 06/13108
City of Atlantic Beach
APPLICATION NUMBER
Building Department (To be assigned
800 Seminole Road bythe Building De0artment)
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
E-mail: building-dept@coab.us Date routed: 7/1 LQ
City web-site: hftp://www.coab.us L
APPLICATION REVIEW AND TRACKING FORM
Property Address: &AJ7(1,_D--/- Denartment review required Y -No
Applicant:
i;�7' /7 S -rie It C 7Yrki Planning &Zoning
Tree Administrator
Project: ::�J71-)JaCj, Public Works
Public Utilities
Public Safety
Fire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
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:
APPLIPATION STATUS
Reviewing Department First Review: EJApproved. FDenied.
(Circle one.) Comments:
ADI'N G
PLANNING&ZONING Reviewed by:-- Date7-7-09
TREE ADMIN.
Second Review: []Approved as revised.
ID d.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: OApproved as revised. F-]Denied.
comments:
'7evievLred by: Date:
Revised 0511VO9
CITY OF ATLANTIC BEACH
APPLICATION FOR BUILDING PERMIT
0,,-:i,er Aquatic Gardens Joint Venture Address P.O.Box 24627, JAX FL.
P Phone 268-8612
t-e c t-- Douglas J. Snead, Jr. Address 7601 Alton Ave.. Jax FL Phone724-8740
(,ontractor J'arnes B. Jaffa Address P.0-Box 24627, Jax.,FL. Phone 268-8612
!,jueiise Number CG CA01597 Expiration Date June 1987
Block # -Subdivision_Aq�tjc Gardens Zoning
t 736A Cl Uzi t i c .Drive Between Atlantic Blvd. and Royal Palms
sideAtI.13ch. \111
Purpose of Bui 1 ding Residential__Type Const - woo d f rcmio
11�1 ions Bu'ildi-ng_.___—.—Lot-----Sz . Footings 12 x
e rs-- Sz . Sills Greatest Span Sills
1 ing Joists rafters Distance on Centers24" o.c.- Greatest Span2411 o.c..
�-'Ioor Joists slab Distance on Centers Greatest Span -----
e r s sce plan Distance on Centers 24" o.c. Greatest Span 24" o.c.
L' IlgAir tc, air heat puff*lid-Filled Ground solid Roof
shingles
I'lo—i Zone-- C If located within a FLOOD HAZARD ZONE fill out
reverse of this application.
i !�:)ucLioris Required.
'�%Then steel is in place and ready to pour footing.
'�%Iien steel is in place and ready to pour columns/lintel.
',-,I)cn steel is in place and ready to pour beam.
1'�Then framing, mechanical , rough plumbing and fire place
is completed and ready to cover up .
5 . Rou'ah electrical.
6 . Final inspection.
!-?I C-�ise of rejection, reinspection MUST be called
after corrections are made . SETBACKS
ITI consideration of permit given for doing Rear Lot --Line--
f'lie work as described in the above statement ,
we ht2rehy agree to perform said work in
—COCdance with the attached plans and
T H.
erifications , which are a parthereof, and
" Il �-Iccordance with the building regulations (D (D
(' f L'�'e City of Atlantic Beach .
0 0
rt rt
(D (D:
OWNER
BUILDF�
Front Lot Line
FLOODPLAIN DEVELOPMENT INFORMATION
Type of Development : New Building
—Alterations to Existing Building
Flood Zone
Required Floor Elevation_
Actual (as built)Lowest Floor Elevation
If located within a flood hazard zone (zone A) a survey must be
made after the slab has be�_�qured, certifying that the "lowest
floor
::: I 1: 1, �::: I � Yi:ii is equa to o-r—a-E—ove the base f lood eleva-f�ion
estab1717sed�or that zone .
No Final Inspection will be made and No Certificate Of Occupancy
will be issued until the survey is on file with the Building Departrner!�- .
COMMENTS
Applicant acknowledgement : I understand that the issuance of this
permit is contingent upon the above information being correct and
that the plans *and supporting data have been or shall be provided
as required. I agree to comply with all applicable provisions of
Ordinance No . 25-7-11 and all other laws or ordinances effecting
the proposed developemnt .
Date— Applicant ' s Signature_
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Department Use
Survey filed with the Building Department on
Certified Lowest Floor Elevation
Required Lowest Floor Elevation
Building Department Representative