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Permit 1745 Selva Marina Dr windows CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Irv) 1 Application Number . . . . . 11-00001612 Date 1/31/11 Property Address . . . . . . 1745 SELVA MARINA DR Application type description WINDOW AND/OR DOOR Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 3300 ---------------------------------------------------------------------------- Application desc WINDOW REPLACEMENT/10 WINDOWS ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ LEROUX OWNER 1745 SELVA MARINA DR. ATLANTIC BEACH FL 32233 ---------------------------------------------------------------------------- Permit . . . . . . WINDOW AND/OR DOOR PERMIT Additional desc . . Permit Fee . . . . 70 . 00 Plan Check Fee 35 . 00 Issue Date . . . . Valuation . . . . 3300 Expiration Date . . 7/30/11 ---------------------------------------------------------------------------- Special Notes and Comments *2007 FLORIDA BUILDING CODE W/2009 REVISIONS NATIONALELECTRIC CODE *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. WINDOW AND DOOR INSPECTION: *INSTALLATION INSTUCTIONS REQUIRED *ALL STICKERS ARE TO REMAIN ON THE WINDOWS *PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 70 . 00 70 . 00 . 00 . 00 Plan Check Total 35 . 00 35 . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 109 . 00 109 . 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 -777 OWNER / BUILDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING"REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. I 11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(l). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826)IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. z2zr W11k_ ADDRESS PHONE NUMBER ]Af� PRINT W - � 3�- ��1113_11AU DATE 2'0 Before me this dav of in the county of T6n DEBORAH A.WHqE Duval,State of Florida,has pe ,pfly appeared herin by himself/herself and affirms that all statements and declarationg-arb t d curate My COMMISSION#DD 634126 Notary Public at Large,State f County of EXPIRES:May 21 2011 BOW T ruN pbL-bnderwNtw, 11 Personally Known 4-7 -a "T duced identifir tion Notary Signature: F/BLDG/O�er-BuilderAffada",OV"ISE�.D: 4/16/2009 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach, FL 32233 Office (904)247-5826 Fax(904) 247-5845 M F2 rn) r-2 n m r-� F) Job Address: 0 U) I L' LL' U 1�j 22 Permit Nui 1,�e_r: a Z�- /' - JAIN b a �u I I j Legal Description Parcel 9 Floor Area of Sq.Ft. Sa Ft Valuation of Work —Proposed Work heated/cooled -heatedle-opled ((-�ef(.,— Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s)(circle one):. Commercial 4zskkntLa1_ If an existing structure,is a fire s kt r sv Florida Product Approval#,194 prini e- stem installed. Circle one): Yes __N_Q_ N/A NA 2 For multiple products use Product-approval orm Describe in detail the type of work to be performed: (Lk rn Property Owner Information: t%Tame: C;:J�A I )ic/ Address: mvvy k1k city cjtC J:�?e. State�'- Zi P�b_nne ::ki) "�;_D ULLt E-Mail or Pax#(Optional)---- ,Ie*m cw__�- ILO ce"� Contractor Information: -ompany Name: Qualifying Agent: .kddress: city -State zip Dffice Phone I ax 4 3tate Certification/Registra-tion 4— IT)F CoADI I krehitect Name&Phone# C B nOF AT SE I 4—N,T.1 EA ,:ngineer's Name&Phone EPFRM ADDfTfONAI, REQUIREMENTS A Nn �ee Simple Title Holder Name and A ss 3onding Company Name and Addres ru Aortgage Lender Name and Address REVMWEDBY:__Lg�� DA-M.- h d per d the work I 0� a ere a e na 4"nallation has live the c 0 m _it t 0 Omed to m thisjurisdiction. is ermit M,q n7fll r t on: or andonedfor a period ofsix Mon at time a p r iis ms fter t to 0"a'r �e e bing,sikns, Weas, PWnIN, urnacev Rni er,Heaters, s i y d hat all w kw bepe pp 5 uance o aperm t an w" t w, wd V,'d k ened thin ft(6 'mm u rstan t at s' k 2en d nde d Par, s Ir C"�ft' rs c ne ,et_ WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMAIENCEMIENT MAY RESULT IN YOUR PAYING TWICE FOR EWROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH YOUR LENDER OR AN ATTORNEY 13EFORE RECORDING YOUi NOTICE OF COMM[ENCEM[ENT. hereby cer!ify that I have read and examined th' 1' ation and know the same to be true and correct. Aliprovisions oflaws and ordin ces governing.this I' an work will be coTplied with whether%ecS!fiP§'hc,rein or not. The granting of a permit does not presume to give authority to violate or cancel the rovisions ofany otherfederal,state, or local aw regulating construction or the peTyormance ofconstruction. �ignature of Owner Signature of Contractor Print Name rint Name .......................................................I...............................................K........................... .......**...............*................................. .......... ..............*"**"*......................... 40 qkd subscribed re me Sworn to and subscribed before me 3�is D of 20_/� this —Day of 20 Totary Public DEBORAH A.WHITE Notary Public 1 6 MY COMMISSION#DD 634 2 EXPIRES:May 21,2011 Revised 01.26.10 on B dad Thru Notary Public Underwriters '. % , k� APPLICATION NUMBER City of Atlantic Beach Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 fit E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: /1 7 M&Ino _D&padment review required Ye"' No Building ) Applicant: J' 60—;� Planning &Zoning .0 0 Tree Administrator Project: M W/ 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: APPLICATION STATUS Reviewing Department First Review: MApproved. FDenied. (Circle one.) Comments: Q�Dl G PLANNING &ZONING Reviewed by: /Y7 Date:i- 3/ TREE ADMIN. V Second Review: F]Approved as revised. FDenied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: DApproved as revised. E]Denied. Comments: Reviewed by: Date: Revised 05/14/09 JAN-31-2011 13:50 FROM:CLERK OF COURTS 904 270 1512 TO:92475845 P:1/1 NOTICE OF COMMENCEMENT PermitNo.– 11-1612, Tax Folio No. State of Florida,County of Duval THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with Chapter 713,Florida Statutes,the following information is provided in this Notice of Corm-nencemeriL Description of property(legal 4escription of property and address if available): 167.& 1-7#J ANAV D&, AN4' 4-4 Fl, S-2,-2,0A 2. General Descri provemenisL "'ption of inil 3. Owner Information: 2)8 4 - e2O/ -S a)Name and Address 7K_ b)I nterest in property: c)Name and address of simple titleholder(if other than owner): 4. Contractor Information- a)Name and Address; Cal t2P&W'-< t&?�O V-X b)Phone Number: 5. Surety Information: a)Name and Address: b)Phone Number: c)Amount of Bond:S 6, Londcr 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(1)(a)7,Florida Statutes: a)Name and Address: b)Phone Numbers of Designated Person: 8, In addition to himself/herself,Owner desipates of to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes. a)Name arid 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 rrom the date of Recording unless a different date is specified: WARNING TO OWNER: ANY PAYMENTS MADE BY TBE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMM.FNCEMENT ARE CONSIDERED IMPROPER PAYMEWI'S UNDER CHAPTER 713,PART 1. , SECTION 713,13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOP, IMPROVEMENTS TO YOUR PROPER'ry, A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSnD ON THE.JOB SITE BEFORE THE FIRST INSPECTION, IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. The foregoing instrument was acknowledged before me this 3 1—�rday of 20 Z- NOTARYPI=ICSTATE CIF,�ORIDA, DOWMILWHn Print Name: X Al U4, WC0MWSqM#DD8Ai26 I I Personally Known -�ddentffication/Type: Verification pursuant to Section 92.525,Florida Statutes.Under penalties o rjury,I decl, that I have read the foregoing and that the facts stated in it are true to the best of my knowle belief. OR k3K ITA= V99e'C)'5, a 0 Pro 0— NUIribor Paqes�1 7/ Rml)rdw 6i 131(��01 I;p�12:56 PK J,M f-ULLER CLERK CIRCUIT COVR–,CUVAL CQUNT'f RECORDING$10-00 Revised 10/1/2009 j7- CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5826 Application Number . . . . . 11-00001612 Date 1/31/11 Property Address . . . . . . 174S SELVA MARINA DR Application type description WINDOW AND/OR DOOR Property Zoning . . . . . . . TO BE UPDATED Application valuation . . . . 3300 ---------------------------------------------------------------------------- Application desc WINDOW REPLACEMENT/10 WINDOWS ---------------------------------------------------------------------------- Owner Contractor ------------------------ ------------------------ LEROUX OWNER 1745 SELVA MARINA DR. ATLANTIC BEACH IFL 32233 ---------------------------------------------------------------------------- Permit . . . . . . WINDOW AND/OR DOOR PERMIT Additional desc . . Permit Fee . . . . 70 . 00 Plan Check Fee 35 . 00 Issue Date . . . . Valuation . . . . 3300 Expiration Date . . 7/30/11 ---------------------------------------------------------------------------- Special Notes and Comments *2007 FLORIDA BUILDING CODE W/2009 REVISIONS NATIONALELECTRIC CODE *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. WINDOW AND DOOR INSPECTION: *INSTALLATION INSTUCTIONS REQUIRED *ALL STICKERS ARE TO REMAIN ON THE WINDOWS *PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS ---------------------------------------------------------------------------- Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 00 STATE DBPR SURCHARGE 2 . 00 ---------------------------------------------------------------------------- Fee summary Charged Paid Credited Due ----------------- ---------- ---------- ---------- ---------- Permit Fee Total 70 . 00 70 . 00 . 00 . 00 Plan Check Total 35 . 00 3S . 00 . 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 . 00 Grand Total 109 . 00 109 . 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 OWNER / BUILDER AFFIDAVIT 1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU RAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE-OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. 11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(l). AN"OCCUPATIONAL LICENSE"IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE BUILDING DEPARTMENT(247-5826)IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. Anix A-, 2�zr s)e/Ila', ADDRESS PHONE NUMBER a40_;\15 X PRINT RINT SIGNZA DATE Beforemethis— ayof 2Q-f/// in the county of Duval,State of Florida,has per n ly appeared herin by himself herself and affirms that Aq V,� DESOR all statements and declarati n t d curate kH A wHrM MyC0MV1SSI()N#DD634I26 Notary Public at Large,Stat of County of . .....7 EXPIRES:May 21,2011 —ad Th Notary 0 Personally Known duced Identification Notary Signature: ff F:/BLDG10wner-EIuiIde4rAffad..,, IVIIED: 4/16/2009 BUILDING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach, FL 32233 Office (904)247-5826 Fax(904) 247-5845 m rr�� m n vmn F� F-) ILI & Un U Uj Job Address: ITA/1 k Permit Nui i r: .Zj Z/h�c;- Legal Description Floor Area of Sq.Ft. Parcel 9 JIAIN b 0 LU I I Valuation of Work Proposed Work heated/cooled Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structureQ) (circle one): Commercial 42S_*nt'W___ If an existing structure,is a fire s kl w stein installed? prin e s Yes _Nja_ N 1A �ircle one): Florida Product Approval#J 47010k I/ t6 For multiple products use'product7app—roval form Describe in detail the type of work to be performed: 01 J, a(Lk 01 1 VL S-6, Property Owner Information: game: d )16 Address: r,ity State�,--Zip Phone E-Mail or ax#(Optional) ewn co� Contractor Information: 11 -ompany Name: Qualifying Agent: ALddress: city -State- Zip Xfice Phone 0 ----,Fax A 3tate Certification/Registration 4 D FOR CODE Coluny If A ILT*"" ALrchitect Name&Phone My OF AT ---LANRCBE' JL:dt1%_11 ,'� SEE PFRmM y,() Engineer's Name&Phone# -RADDf"()NAr "M ,ee Simple Title Holder Name and A ess REQUIREmENTS A Nn C()N0j44()N5. 3onding Company Name and Addres A 11 1 If r P PV I vlortgage Lender Name and Address ED BY:__LLj_j_ I I I I I- WWI I I DATE. to do di er a kbr7ihstallatioa hm 1.0 the construction in thisjurisdiction. Ais permit b�comies null or abandonedfor aWeriod of sixp�)months at any time after Plumbing,Signs, ells,Pools, urnaces,Boilers,Heaters, WARNING TO OWNER: YOUR FAIELURE TO RECORD A NOTICE OF COMN]ENCEMIENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUi NOTICE OF COMMEENCEMENT. hereby cer!ify that I have read and examined th 1* ation and know the same to be true and correct. -411provisions of laws and ordinance governing this "s s )j work will be coTplied with whether sr,,ife§2rein or not. Yhe granting of a permit does not presume to give authority to violate or cancel the rovisions ofany otherfederal,state, or local aw regulating construction or the pe�fbrmance ofconstruction. Z �e�'t-��' �ignature of Owner Signature of Contractor rint Name L Print Name ........................................................................................................OF............................ ............................................................................................................... ............ �wom tq 4 subscribed 1?6%re me Sworn to and subscribed before me 3-is D of 20-J this —Day of 20 �otary Public DEBORAH A.WHITE Notary Public MY COMMISSION#DD 634126 Revised0l.26.10 IV EXPIRES:May 21,2011 B nded Thru Notary Public Underwriters . % , k' NUMBER City of Atlantic Beach APPLICATION Building Department (To be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 - Fax(904)247-5845 fit E-mail: building-dept@coab.us Date routed: /Ir City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM 5, Jispartment review required Yes/ No Property Address: 7 V-<- _ 6 Building ) __z/_ Applicant: __�-Iannlng &Zoning Tree Administrator Project: ke�-' W,lyn)166' 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: APPLICATION STATUS Reviewing Department First Review: EfApproved. E]Denied. (Circle one.) Comments: (��Dl G PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: V ]Approved as revised. FIDenied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: FApproved as revised. ElDenied. Comments: Reviewed by: Date: Revised 05/14/09