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Permit 1918 Hickory Lane (2) r� >� CITY OF ATLANTIC BEACH cc D Ford ,<3 Alt BUILDING / DEPARTMENT ss� 'i• ons 800 Seminole Road - S. �o Atlantic Beach, Florida 32233 (904) 247-5800 (904) 247 -5845 Fax PLAN REVIEW COMMENTS Permit Application # 03 - 0 7 '7 ) 7_2 Property Address: ) 9) ? Hi'C k „ L<1 Applicant: ) l -- E;-) /v..S «s Project: c 'S[° /yen Pr c This permit application has been: Approved Reviewed and the following items need attention: e� . 31 , ti1 741111r ti`s Please re- submit your application when these items have been completed. Reviewed By: Date: 46,, yf r,E+ _. ,(5/.10 ft ' , Pa 0 1 CITY OF ATLANTIC BEACH BUILDING PERMIT APPLICATION (ALTERATIONS /ADDITIONS) f Date: / z a3 Job Address: / / (J /� • Owner of Property: Address: /94 //teeee,eK Telephone: Legal Description: Block Number: • • - , -r: Zoning District: ` . /( Contractor: A \ /tl � y = `i[ ' �. /,L A State License Number: elfeQ; j73,53 Contractor's Address: 26 .444 /i ! . Telephone: Z59 &?9 Fax: 2 92 f/ / Describe proposed use and work to be done: /Il e./ieze (`ish- Present use of land or building(s): Gfi Valuation of proposed construction: ",Q What are the dimensions of the added space: ZS feet x feet Will the added area be heated and cooled? /0 New electrical or increase in service? New plumbing fixtures? 4'li� New fireplace? AO New heating/air conditioning? Is approval of Homeowner's Association or other private entity required? /1O 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? g NO. Applicant certifies that no change in site grade or fill material will be used on this project. ❑ YES. See Step 2 below. Approval of the Public Works Department is required prior to issuance of a Building Permit. jg NO. 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 appropriate. Incomplete applications may result in delay in issuance of permit. STEP 1. Verify zoning designation and proper setbacks for the proposed construction. If you are unsure of this information, please contact the Planting and Zoning Department at 904- 247 -5826. In order to correctly verify zoning designation, please have Property Appraiser's Real Estate Number available. STEP 2. Contact the City of Atlantic Beach Department of Public Works to determine if a pre - construction or post - construction topographical survey or grading plan is required. (If not required, written verification must be provided with this application.) The Department of Public Works is located at: 1200 Sandpiper Lane, Atlantic Beach, FL 32233 Telephone: (904) 247 -5834 STEP 3. Submit Tree Removal Application if trees are to be removed or relocated. STEP 4. Please submit Building Permit Application, Energy Code Forms, Notice of Commencement, Owner /Contractor Affidavit if owner is contractor, and four (4) complete sets of construction plans to the Building Department, which is located at the Atlantic Beach City Hall, 800 Seminole Road, Atlantic Beach, FL 32233 Telephone: (904) 247 -5826 800 Seminole Road • Atlantic Beach, Florida 32233 -5445 Telephone: (904) 247 -5800 • Fax: (904) 247 -5845 • http : / /www.ci.atlantic- beach.fl.us Page 1 Revised 1/14/03 " ' In addition to construction and engineering detail, plans must contain the following information as appropriate for the type of work bein performed. Scale of drawings should be sufficient to depict all required information in a clear and legible manner. g 1. Current survey showing the property boundary with bearings and distances and the legal description. 2. Location of all structures, temporary and permanent, including setbacks, building height, number of stories and square footage. Identify any existing structures and uses. 3. If required by the Department of Public Works, a pre - construction topographical survey. 4. Any significant environmental features, including any jurisdictional wetlands, CCCL, natural water bodies. 5. Impervious Surface area calculations: include driveways, sidewalks, patios and other Impervious Surfaces. Swimming pools may be excluded from total Impervious Surface. 6. Other information as may be appropriate for individual applications. 1 hereby certify that all informati. .rovided with this application is .rr- . /- -- Signature of owner: _ . Air Date: .497//a,..3 1 hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of the laws anc ordinances governing this type of wo 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 Contractor: G� - ,�•r /© Z / Date: ( — Address and contact information of pe on to r ceive all correspondence regarding this application (please print). Name: Lt /, % t t/ /� Tr. e� creQ 9l g 07c /� ° Mailing Address: �¢- �jry�p' Telephone: OS// �Qa Fax _- 7 9Z,/ E - Mail: AS TO OWNER: Sworn to and subscribed before me this Z2 day of J 20 State of Florida, County of Duval _ . re o + + w .... ROY ROCIATI 6 1 = �Y P� C # DD0121151 Notary's Signature: ' ), Expires 5/27/2005 ora o Bonded tluaugh Personally known (000432.4254 Florida N Miff., h1C. ❑ Produced identification Type of identification produced AS TO CONTRACTOR: Sworn to and subscribed before me this ZZ day of "-- 20403 State of Florida, County of Duval r a s +N °,��.,,� ROY RoCKHOLD Notary's Signature e3PZ/9------- s 2f Commission # DD0121151 .:3) ::, ;;;, ys K=ca� F Expires 5/27/2008 Personally known "` ® "° Bonded through C] Produced identification i( Florida Notary Inc Type of identification produced 800 Seminole Road • Atlantic Beach, Florida 32233 - 5445 Telephone: (904) 247 -5800 • Fax: (904) 247 -5845 • http : / /www.ci.atlantic- beach.11.us Page 2 Revised 1/14/03 APPROVED CITY OF ATLANTIC BEACH BUILDING OFFICE OCT 3 0 2003 3D VIEW =,'_ Cage Master U00 CopyRight 1991 -1999 Wilson Software Corp. 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