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Permits 1966 Beach Ave Map Output Page I of I JAXGIS Property Information 2004 St 1072 10" 1050 Copyright 11 vil�--F11947— RE Name Address Total Acres Plat Map fregal Descriptions Flood LandUse Zoning ENT Value Book Panv Zone 1966 09-2S-29E .11 Not in 1695250000 SMiTH BEACH AV 266400 0.1099999994 5/34 PT GOVT LOT 3 RECD O/R 10060- Flood JAMESJJR 357(EX Zone 32233 PT RECD O/R 10 128-1484) lb 41) WAV A/0 http://maps.coj.net/WEBSITE/DuvalMAps/toolbar.asp 11/12/2004 CITY OF ATLANTIC BEACH 800 SENUNOLE ROAD ATLANTIC BEACH,FLORIDA 32233-5445 -5800 TELEPHONE:(904)247 FAX:(904)247-5805 SUNCOM: 852-5800 http://ci.atlantic-beach.fl.us November 26, 2002 James J. Smith, Jr. P.O. Box 51172 Jacksonville Beach, Florida 32240-11 Re: Approval of Subdivision Waiver for PT GOVT LOT 3 RECD O/R 10060-357(EX PT RECD O/R 10128-1484),RE Number 169525-0000 Dear Mr. Smith: This letter serves to confirm that the City Commission, at their November 25, 2002 public meeting, approved a waiver from a Section 24-255 (a) of the City's Subdivision regulations. This waiver will allow Building Permits to be issued on a new lot containing approximately 5000 square feet of lot area, 50.06 feet in width and 100-feet in depth, and as described by the above legal description reference. (Issuance of permits, of course, shall be further subject to compliance with all Florida Building Code requirements and other applicable Land Development Regulations.) Also, please bear in mind that the existing structure on the original "parent parcel" must be demolished prior to construction upon your property or the adjacent parcel. Please maintain a copy of this letter for your records, and I would suggest that you provide a copy of this letter along with any future application for Building Permits. Please feel free to contact me at 247- 5817 or by e-mail at sdoerr(d)ci.atlantic-beach.fl.us with any questions. Sincerely, Sonya7oo`etrr, AICP Community Development Director cc: Don Ford, CBO, Building Official Maureen King, City Clerk 11126102 TUE 11:54 FAX 9042466750 SecureOne Protection zool FAX COVER SHEET secAmbonto Pnx#Cdaft$wvjC&A'wa 1314 N. 3tv Slaw Jb"navgb Sawh. FL 322W 246-WW s"D TO C=pmy name Flom '"n s 0"'1 pt Dofga Dole 0*,-bga&M Oft& ftm Aumbdf p"m Ownaw 2�q-j_ 2'(4 �_ 5(. 0 0 WPM Fl Pop&AW [3 J%sa,mmma J%"o nw;ew Fw~Www&d*fi 6 Ta(W Pam wcjv&q cow. COMAGENTS ................... ----- ... .................................. .................................................................................................................. ­...'­­.................... ................................................................................­_­­__­.......................................... .......... ........................................................ .......­................................ ....................... ......... .......... NOTICE OF AD VALOREM TAXES AND NON-AD VALOREM ASSESSMENTS 2002 REAL ESTATE TAX - DUVAL COUNTY CITY OF JACKSONVILLE LYNWOOD ROBERTS, TAX COLLECTOR 231 E. FORSYTH STREET ROOM 130 JACKSONVILLE, FL 32202-3370 PHONE- TAX COLLECTOR - (904)630-1916 HOMESTEAD INQUIRIES - (900630-2020 WEB SITE AT WWW.COJ.NET ASSESSMENT NUMBER: 169525-0000-0 ESCROW LOAN NUMBER- N/A CODE: N/A LOCATION ADDRESS: 1968 BEACH AV LEGAL DESCRIPTION SMITH, JAMES J JR 09-2S-29E US03 1960 BEACH AV PT GOVT LaT 3 ARCO O/R 10060-357(EX PO BOX 61172 PT ARCO O/R 16128-1484) JACKSOPWILLE 59AW FL 32240-11 . .............. ............................................................. .................................. ....................­........ A P A I L) A P P 1� 0'c A,L.0 V ED CITY ,NTIC BEACH OCT 3 11983 11983 PLUMIBING WOTRYSHEET BY S IN K S SHOWERS DISHWASHERS CLOSETS BATH TUBS FLOOR DRAINS WASHING MACHINE WATER HEATERS DISPOSALS LAVATORY URINALS OTHER TOTAL FIXTURE COUNT r 0-0* 6 AS FIXTU'RE U`NTlT -BREAKDOWN FIXTURE UNITS ARE ESTABLISHED AS THE MEASUREMENT OF WATER DEMAND FOR EACH WATER FIXTURE UNIT INSTALLED AND CON-NECTED TO THE CITY WATER SYSTEM. THE WATER SUPPLY CHARGE IS HEREBY 6 FIXED AT $10.00- PER FIXTURE UNIT CONNECTED TO THE CITY WATER SYSTEM. BATEROOM GROUP CONSISTING OF LAVATORY (1 UNIT) WATER CLOMT, LAVATORY, AND BATH TUB OR SHOWER STALL SERVICE SINK TRAP STAND (6 UNITS) 4� (3 UNITS) DRINKING FOUNTAIN UNITI URINAL, WALL LIP (4 UNITS) FLOOR DRAIN (I UNIT) WASHING MACHINE RES. URINAL, PEDESTAL, SYPHON (3 UNITS) JET BLO14OUT (8 UNITS) WATER CLOSETS, VALVE OPERATED WATER CLOSETS, TANK—OPERATED (8 UNITS) (Z�UNITS) SHOWER STALL, DOMESTIC BATHTUB (W/OR W/O OVERHEAD (2 UNITS) SHOWER) (2UNITS) LAUNDRY TRAY BIDGET (3 -UNITS) (2 UNITS) DI SW.-.ASBER C2 U-NITS) KITCHEN SINK (2 UNITS) KITCHEN SINK/WASTE GRINDER (3 UNITS) TOTAL FIXTURE UNITS $10..00 'EACH, /20- oc-', P A I D at4e- � ' APPROVF-0 OCT 3 11983 jTY OF A IG BEACH NG OFFiCS r, I ' 8'jl PLU�IBING WORKSHEET SINKS SHOWERS D I S3Hl-.7AS H E RS CLOSETS BATH TUBS FLOOR DRAINS WASHING MACHINE WATER HEATERS DISPOSALS LAVATORY U'RINALS OTHER TOTAL FIXTURE COUNT FIXTURE UNIT BREAKDOWN L�-3 -5�z FIXTURE UNITS ARE ESTABLISHED AS THE MEASUREMENT OF WATER DEMAND FOR EACH WATER FIXTURE UNIT INSTALLED AIND CON-NECTED TO THE CITY WATER SYSTEM. THE WATER SUPPLY CHARGE IS HEREBY FIXED AT $10.00 PER FIXTURE U-NIT CONNECTED TO THE CITY WATER SYSTEM. BATHROOM GROUP CONSISTING OF LAVATORY (1 UNIT) WATER CLOSET, LAVATORY, AND BATH TUB OR SHOWER STALL SERVICE SINK TRAP STAND (6 UNITS) (3 UNITS) DRINKING FOLTINTAIN (!,, UNITJ URINAL, 14ALL LIP (4 UNITS) FLOOR DRAIN (I UNIT) WASHING MACHINE RES. URINAL, PEDESTAL., SYPHON (3 UNITS) JET BLOWOUT (8 LTNITS) WATER CLOSETS, VALVE OPERATED lof-, WATER CLOSETS, TANK-OPERATED (8 UNITS) (4UNITS) SHOWER STALL, DO-MESTIC BATHTUB (W/OR W/O OVERHEAD (2 UNITS) SHOWER) (2UNITS) LAUNDRY TRAY BIDGET (3 UNITS) (2 UNITS) DISII�-.'ASHER C2 LINITS) KITCHEN SINK (2 UNITS) KITCHEN SIW, /I,.'ASTE GRINDER (3 UNITS) TOTAL FIXTURE UNITS $10..00. EACH- 5170.00 Duval County Property Appraiser 2003 Certified Tax Roll Matching Record Cards Page I of I Duval County 2004 REQUESTED BY: Z ZIPPERER RUN 10/12/2004 08:25 AM 09-2S-29E .11 SMITH, JAMES J JR 553 4-9409- PT GOVT LOT 3 RECD O/R 10060-357(EX PO BOX 51172 1966 BEACH AV PT RECD O/R 10128-1484) JACKSONVILLE BEACH, FL 32240- ATLANTIC BEACH LAND VA STYLE 01 BLDG NO. 001 ------20------- MISC VA Bldg Use : 0102 SFR 2 STORY SOH I I BLDG VA Ex-Wall 1: 1550 CONC BLOCK 50% 1 1 CAMA VA Ex-Wall 2: 2650 ALUM. SIDING 50 16 FST(320) 16 VALUE B Roof Str 03 GABLE OR HIP I I ASSESS Roof Cvr 03 ASPH/COMP SHNGL I I EXEMPT In-Wall 1: 0300 PLASTER +-9---+-8------ TAXABLE In-Wall 2: 0000 N/A interior wall 2 6FSP(48) SR EX V Flr Cvr 1: 1400 CARPETING +---15-------ll-+-+ SR TAXA Flr Cvr 2: 0000 N/A I I APPRAIS Heat Fuel: 04 ELECTRIC I I DATA Heat Type: 03 FORCED/NO DUCT I BAS(724) I PROP US Air Cond : 03 CENTRAL AIR I FUOI(676) 26 Tax Dis Bathrooms: 002.0 2.0 BATHS 26 1 NBHD Bedrooms 03 03 BEDROOMS I I L100 Stories 001.0 1 1 EXEMPTI Quality 31 AVERAGE I 1 0604 Hrs.Spent: 00 --------26--------- Minutes : 31 Rms/Units: 0000 BAS(U26FU01(R15FSP(U06RO8 DO 6L8)RllD26L26U26)RISU06FST Act Mo/Dy: 0000 L09Ul6R2ODl6Lll)ROBD06RO3D26L26) Act Yr Bt: 1961 EFF ARE Eff Yr Bt: 1961 SQFT RA Depr Tabl: 11 POINTS Func Obs%: 00 RCN Econ Obs%: 00 AREA GR AREA PCT AJ AREA RCN RCNLD DEPR ObsrvCond: AP ABNORMAL PHYS BAS 724 100 724 61974 20296 OBSOL Obsry %: 025 FU01 676 100 676 57866 18951 BUILDIN FSP 48 55 26 2226 �29 FST 320 55 17 r. 15066 4934 BOOK PAGE 10060 0357 Deed Type: 03884 0397 PROPERTY NOTES Deed Type: PERMIT NO 3/6/02 PAP-IKH NOH CUTOUT # 000000779 556. RE 169525-0050 WAS CUT OUT OF THIS PARCEL FOR THE REC BLDG CODE DESC LENGTH WIDTH UNITS ADJ PRICE EYB DT PCT ADJU MIS REC LUSE DESC ZONING FRONTAGE DEPTH UNITS TP ACRES PRICE AJ REASON AJ 1 0101 SFR F ARG-2 50.00 100.00 50.00 F .11 5000.00 DP 4 LAN http://apps2.cQj.net/pao/prc.asp?PRC—RENO=169525+0000&PRC—BLDG=l 11/12/2004 11886 IDEPAI"i tITYOF _:NTIP., MCH MWT, INFO AT LOCATION xxFoRmkTION rose*., Add 66 ' EXAC11 i't-TYp �IUTILIVIE ja ' S vim 0, ATLANTIC�' SRACH, IFLORi v 3 2 2 3�,!3 ---------- LZOAL DZSCRIPTION Tyi>*;WOOD,, pRA,,M-X Z 0-Sr OLE rAk"ILY: L 0 mtd ' , , I Twp. Sel�tio 0 Subd: 0 Rngr: 0 SubdivisiqniNoRTjj,. ATLANTIC. tZAca V-*Iue-. 0 0'0 Cost : 00 250 �'00 rims -'FQR ABAQ E glalt TION �APPLI,CATION FEU ---------- tit'' WATER1 m T FXL FLORIDA . 11 1 1 1 1 - R/ 4 ORMATI At"-: flu ic PAR A NOT#Pft--�-A,LL 0ONcR9Tg�-pORpAS,AND FOOTINGS MUST 89INSPECTED BEFORE POURING, PERMIT VOID tiX MONTHS AFTER ISSUE' DAMOF M�AT RK MUST NOT,BEPLACED IN PUBLIC SPACE U AND MUST BE OR"OWNeA , ANIC'S f Y WMSIULT I ' I RE TO �'COMPIL -WfTj+T N* -fitMECHI LAWQA GTWlCEF0Ri*' IMPRO, MENTS" ED ING� CCORD 10APPROV OLANS,WHICH ARE PART OPTHISP ERM T ANOW EUECTTO�Ro OP*AP pW'VI.SIONS�pr'LAW. kot 1071% 01 ATLANTIC.BEACH,BUILD ar WNW" J DEPARTMENT OF SUILDIN43 CITY OPATLANTIC BEACH Z" ORM IT 114F r ATION ------ �rmi t,-,NUMbe r LOCATION iNFORMATI:ON 1,3531 AddreSS 1966 BEACH AVRX�E Type PLVX&jNd� 0 ANT I t Work,-ALTERATION C BEACH,�. FLORIDA 322�3 -------- LW&L DESCRIPTION --- L Type:W �b]D FJF" r I Ly 'Lot,*. O$ed Use-SINGLE PAM � Twp. 0 8u' bd W, set�t i on inc is Rag. ubdivisi It t VAhie: on*NORTH :ATLANT.I:C BEACH 0 .:00 Mp'r 0 V. C 0 S t 00 Total F- e .00 Amout�t'. 0 &"44 ON APPLICATION FEES ---------- PEPxiT 25 00� FLORIDA g 4 cat 4 PfWATr I ON INo r qt J�, 9 -7 J'A S� N W4 e FL 32,224 9 zxp, j40TE,#. NOTICE CONCRETt FdAJOSAND FOOTINGS M ust SO INSPECT 469FOAE PPU01 NG *rE OF ISSUE PeRMIT V61D SjXr MONTHS AFTE A DA No S WILDING MATERIAL,RUBBISH ANPOIESAI&FROM THIS WORK MUST E -ITHER CONTRACTOR OR OWNEAr­1' p 8LIP'SPACE,AND MUST BE CLEARED UPAN0,HAULED.,AWAy,8yrF 4AC,E,bJk v LY-WITN THE MECHANrICS' LIEN 1 LAW CAK �V ,:T"v-PROO ATY ib IN J$ R j V I R."PAYING TWICE Pon"71sutum4d,i P, 0 EM� ENTS& WFOR I DING D RT ENT By, 7 CITY OF ATLANTIC BEACH APPLICATION FOR PLUMBING PERMIT 11601, JOB LOCATION: AM) 8 IeA C 0 A V OWNER OF PROPERTY: o e -y 4A, Ru XAd PLUMBING CONTRACTOR Pt <c o CONTRACTOR' S ADDRESS: STATE LICENSE NUMBER: crcol2s53 TELEPHONE: HOW MANY OF THE FOLLOWING FIXTURES INSTALLED SINKS SHOWERS LAVATORY WATER HEATERS BATH TUBS DISHWASHERS URINALS DISPOSALS CLOSETS ----YASHING MACHINE FLOOR DRAINS SHOWER PANS OTHER S464,16L TOTAL FIXTURES: $3 . 50 + $15 .00 MINIMUM PERMIT FEE .00 SIGNATURE OF OWNER: SIGNATURE OF CONTRACTOR:. ----------------------------------------------------------------- INSTALLATION OF PLUMBING AND FIXTURES MUST BE IN ACCORDANCE WITH THE MOST RECENT EDITION OF THE SOUTHERN STANDARD PLUMBING CODE. CALL A DAY AHEAD TO SCHEDULE INSPECTIONS - (904) 247-5826 SEWER CONNECTIONS MUST BE CALLED INTO PUBLIC WORKS FOR INSPECTION PRIOR TO COVERING UP ( 904) 247-5834 DEPARTMENT OF PUBLIC WORKS EROSION & SEDIMENT CONTROL INSPECTION Date 1'2 - 2J- 03 Timej-�� Permit# Inspector 04F--o Project Name/Location Q-a Contractor's Name/Ad :�:�a Stage of Construction Zn 7- YES kJ0, NA 11 0 1. Ali required erosion and sediment control measures are shown on plan. 11 2. Ali 9M fences are properly installed(staked in and trenched in)and In good condition. 13 3. AN disturbed areas an properly stabiliza.Temperury or permanent stabilization Is required. 101 [1 4. An d...tering operations turbidity readings am 5 29 ntu above natural background readings. Note,turbidity readings must not be above background levels for Outstanding Florida Waters. 0 El AD construction entrances are free ftom soll and mud tracking. 0 0 6. AN above ground water Impoundments an stabilizedL 0 0 7. Ali stormwater Inlets an adequately protected from sedhoentL 11 b & AD stormwater ponds and conveyance systems are stabilized and ftw of sediments. 11 9. AD receiving waters are adequately protected with floating turbidity curtains or other means as needed. 10. Sediment traps am Installed as needed and are In good working order. 0 0 11. AD soll stockpiles are adequately stabilized. 12. Ali preservation wetlaW and conservation areas am dearly marked and adequately x protected 11rom sft erosion and turbidity. 13. Ali alum/water treatment systems operating properly and coordinated with DPW. 14. Notice of Intent(NO[) (FDEP Form 62-621-MO(4)(b)has been submitted to YDEP. 0 15. The Stormwater Pollution Prevention Plan(SWPPP)is on site. D 0 16. The required Inspection and maintenance report forms am always completed. Commem(ts. JJ,7 J�Le C Or' QJ(Q-t-4h' 0-J -LK��Se,ed' NOTE: Failure to comply with erosion and sediment control rules and regulations in a timely numner may result Isk PERMIT VIOLATIONS,mod ENFORCEMENT ACTIONS may be taken by City Of Atlantic Beach,SJRWMD,FDEP,and U.S.EPA. Letters of Violations,Stop Work Orders,and Fines may be Issued for Permit Violations. Please contact Public Works Department at 904-247-5834 or Fax 904-247-M43 for any questions or concerns. Verbal/Written notification given to: 4e-m- L,/ & / Company e - hone# — - I ::S:—, S,-' I Inspector Signature CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FLORIDA 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 03-00027312 Date 12/01/03 Property Address . . . . . . 1966 13EACH AVE Tenant nbr, name . . . . . . DISCONNECT SEWER Application description . . . PLUMBING ONLY Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 Owner Contractor --- ----- - -- ------ ----- -- -- -- - -- - - -- -- - --- --- - - -- SMITH, JAMES GLASS PLUMBING 19S7 BEACH AVENUE 5855 RANSOM ST ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32211 (904) 745-6302 -------- - --- ---- - ------ -- -- - ---- ----- - --- - - - -- - - - - - - -- - - - - - --- - - - - -- - - - - - - - - Permit . . . . . . PLUMBING PERMIT Additional desc . . Permit Fee . . . . 42 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Fee summary Charged Paid Credited Due ----------------- ---------- - - ---- -- -- - - - - --- - -- - - - - - - - - - - Permit Fee Total 42 . 00 42 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 42 . 00 42 . 00 . 00 BUILDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER. "FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS"ISSUED ACCORDING TO"PROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. BUILDING OFFICIAL U CITY OF ATLANTIC BEACH PLUMBING PERMIT APPLICATION Date: Property Address: owner: �_Jurrr_!�> Sry%ilk Telephone#: Contractor: Telephone#: Contractor Address: V\S G rVA_S -—_ 'Fax#:_2 �O in consideration of permit given for doing the work as described in the above statement,we hereby agree to perform said work in accordance with the attached plans and specifications which are a part hereof and in accordance with the City of Atlantic Beach ordinance and standards of good practice listed therein. Installation of plumbing and fixtures must be in accordance with the most recent edition of the Southern Standard Plumbing Code. Plumbing Type: If other construction is being done on this building or site, • New list the building permit number: • Re-Pipe Number of Fixtures: Bath Tubs Showers Closets Shower Pans Dishwashers Sinks Disposals Urinals Floor Drains Washing Machine Lavatory Water Sewer Water Heaters Other Fees Permit Issuing Fee: $35.00 Total Fixtures: X $7.00 + $35.00 800 Seminole Road-Atlantic Beach, Florida 32233-5445 Phone: (904) 247-6800- Fax: (904)247-5845- http://www.cf.atlantic-beach.tl.us ki N CITY OF ATLANTIC BEACH 800 SENIINOLE ROAD ATLANTIC BEACH, FLORIDA 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 03-00027073 Date 10/10/03 Property Address . . . . . . 1966 BEACH AVE Tenant nbr, name . . . . . . DEMO HOUSE/DEBRIS Application description . . . DEMOLITION Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 0 Owner Contractor --------------- -- ------- -- ---- ------- - -- - ------- SMITH, JAMES J. JR. OWNER ATLANTIC BEACH FL 32233 (904) 509-1100 ------------------------------------------ -------------- ---- ---------------- Permit . . . . . . DEMOLITION PERMIT Additional desc . . Permit Fee . . . . 100 . 00 Plan Check Fee . 00 Issue Date . . . . Valuation . . . . 0 Fee summary Charged Paid Credited Due ----------------- ---------- ---------- --- ------- ---------- Permit Fee Total 100 . 00 100 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 100 . 00 100 . 00 . 00 . 00 BUILDING MATERIAL,RUBBISH AND DEBRIS FROM THIS WORK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED UP AND HAULED AWAY BY EITHER CONTRACTOR OR OWNER. "FAILURE TO COMPLY WITH THE CONSTRUCTION LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS-ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOR VIOLATION OF APPLICABLE PROVISIONS OF LAW. BUILDING OFFICIAL CITY OF ATLANTIC BEACH DEMOLITION PERMIT APPLICATION Date: Job Address: 91E4cJ4 AvE - Owner of Property: J A Ckj6 S J-INA t -T[ J V;� Address: VI-23 6EACH 20f cl- Telephone: �5 6 C1 t 0 Legal Description: Block Number: Lot Number: Zoning District: Contractor: o W N102— ( S eup) State License Number: Contractor's Address: br i&OL-- Telephone: &h ax— Fax: Describe-proposed use and work to,be done: QfAoLk-Q-f �4ou J6 A/\JO 9�&M&VC-- - 'VE60-05 Present use of land or building(s): Is approval of Homeowner's Association or other private entity required? M_Q If yes, please submit with this application. Will this project involve changes in elevation,site grade or any use of fill material or the removal of any trees? XNO. Applicant certifies that no change in site grade or fill material will be used on this project. El YES. See Step 2 below. Approval of the Public Works Department is required prior to issuance of a Building Permit ONO. Applicant certifies that no trees will be removed for this project. YES. Removal of Trees will be required for this project. 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 appropriat . Incomplete applications may result in delay in issuance of permit. STEP 1. Attach Tree Removal Application if trees are to be removed or relocated. I hereby certify that inf6 ation ovided with this application is correct. Signature of Own6r. Date: ill I hereby rtify that I have ad and examined this application and know the same to be true and correct. All provisions of the laws and ordinan ove is 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. 800 Seminole Road -Atlantic Beach,Florida 32233-5445 Telephone: (904)247-5800 -Fax: (904)247-5845 -http://www.ci.atiantic-beach.fl.us Page 1 Revised 1/14/03 Signature of Contractor: Date: Address and contact information of person to receive all correspondence regarding this application (please print). Name: Cj rrftAjC—:5 j, 5-AA.C-T W 6 C3 JC Mailing Address: Vt 5 in Telephone: lo,�-t— cc, Fax: E-Mail: AS TO OWNER: Sworn to and subscribed before me this day of �20_3 State of Florida,County of Duval Notary's Signatur JENNIFER SCHLUETER MY COMMISS ION#00 121301 ow M Personally know EXPIRES:May 27,2006 BmIed Twu Nftry pubk OrKwOols E4-1�roduced identification Type of identification produced AS TO CONTRACTOR: Sworn to and subscribed before me this day of 20_. State of Florida,County of Duval Notary's Signature: Personally known Produced identification Type of identification produced 800 Seminole Road -Atlantic Beach,Florida 32233-5445 Telephone: (904)247-5800 -Fax: (904)247-5845 -http-//www.ci.atiantic-beach.fl.us Page 2 Revised 1/14/03