Permit Fence 46 15th St 2011 `$ ,. CITY OF ATLANTIC BEACH
r' ,14t! % ' 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
Application Number 11- 00001860 Date 5/02/11
Property Address 46 15TH ST
Application type description FENCE PERMIT
Property Zoning TO BE UPDATED
Application valuation . . . 2500
Application desc
36 in picket fence
Owner Contractor
BOENEEKE NELIGAN CONSTRUCTION (BLDG)
46 15TH STREET PO BOX 49249
ATLANTIC BEACH FL 32233 JAX BEACH FL 32240
(904) 270 -0067
Permit FENCE PERMIT
Additional desc .
Permit Fee . . . 35.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 10/29/11
Special Notes and Comments
Roll off container company must be on City approved list
and container cannot be placed on City right -of -way.
Other Fees STATE DCA SURCHARGE 2.00
STATE DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 35.00 35.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 39.00 39.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
_ _ __. ..._
- - • •110°' FLORIDA DEPARTMENT 0;110t#QNADOL: ,#ROTECTION • ''',• - i l l—
- s
- • Bum of Beaches and Coastal Sy - r -sWw
Common wealth Blvd - MS 300
AP R J 2011 pagatmgmber: -8 .214
I FL A oy l Tallahassee, 32399-3000
-- v i samessar( 1150 ) 488-7708
tsue.=:ku (....-F ga No. ofPages Ateorkod:
k i SVC...7E7A_ _
FIELD PERMIT PURSUANT TO SECTIOk Witiii'irei6i.052, FLORIDA STATUTES
FINDINGS OF FACT AND CONCLUSIONS OF LAW: The request for a penult was corindenol by the stiff designee of the Department of
Environmental Protection and found to be in compliance with the requirements of Chapter 62B-33, Florida Administrative Code (FA.C.). Approval is
specifically limited to the activity in the stated 10016'011 and by the project desniption, approved plans (if any), attached standard conditions, and any special
conditions stated below pursuant b Paragraph 161.053(5), Florida Statutes. This permit may be suspended or revoked in accordance with Section 62-
4100, FA.C.
Ntoncr LOCA1101 of 6 41/Lc i
ii. it Affl a' 1
lit -■ 1.A. '41 ......A.A OIL 0 i 11... f- 0
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Oft
(7 ( -4-10 7!- 1 I5 D01 c:_c_c..4..
PROJECT DISCIRWTION: 0 :- mr A ,,... . ,. . . A e Ma A .., - ea A - g ..44.1 Aria■ ....._41—___,
- 0 Al 1. 4610 d ' AM- IMIN 1 4
a, I i k90,,‘ -..-• 12: lauickxted (4 , i 6/4645‘,
rogamm.„,...- ..,1 .Wt.
SPECIAL ERM` CONDMONS: This permit' is valid only after all applicable Weak dote, and load permits age obtoiaed aad does not authorize
conauvadion of bad setback requirements or zoning or buddies codes. This permit and public notice did be posted en the site innnedisidy upon
issuance and AM rennin posted along with local approval anti the eempletion army activity authorized by this permit. Other special conditiow of this
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STANDARD PERMIT COMMONS: The pennit*e dal comply with the atladted dandled fidd vomit etialitiosis.
APPLICANT INFORMATION: I hereby acetify that I ma either: (la) the owner of the subject property rg (1b)I have the own consent to sewn
this permit on the ownees bebalt and Sad (2)1 shall obtain any applicable licenses or permits which may be required by Rant side, candy, or immicipol
law prior to amunescaneat °floe anthodoed yak (3 -, , - . .. that the authorised walk is whet I impnaket sod (4) I accept reaponsibiny for
all
compliance with permit • , .,..,,,, - , _ay...400r
;JP _,...
Appticantk Signature .411Gene -411111r t . Y. Telecthowello. 0. ` - 1- C--
1. 67.•ee r g A PHI, 4 .4 '
App r .2
ticants Printed Name AiTe...±0.,:AirM/Likter Address 7A, . Ay/ _Lekir ffieArr3...24/2
4IP .0
Sendai:lint is on agent / ____
primed name of property ow*, Preflowir 4 to property owner ealepleowe ma
DEPARTMENT FINAL ACTION AND F1LR4G AND ACENOWLIIDGMENT: , / , I , - , , , - , on Wolf of the Deportment ef
PlotedionEavironmental ' Re undasigned dmigaded
/ y
Ala ifffilA
----- 0_7----i-f. Clerk ' Nome ofDesigreso/Doperey Clore ,-, T Z
NOTICE IS ON THR SACK orrins now. EXPIRATION DAM: - r -Zi / .
., og ,,, ironed . , , to Section 62B-33.014, F.A.C., are valid for no more than ninety days and , . --- , - . ore for no more • , r b . ; • •• ._„ .• may speeffy a Roster • ' )
;lf
s
C :3 :4 PERMIT: NO
• I 0 YES Re fill pleas are Macho& )Es ONO
AND () NOTICE CONSPICUOUSLY THE SITE
DEP form 73-122 (Updated 01/06) Thug C010 Office] Treiber CoPY Pi* CoPY - SheDemillmie/
MAP SHOWING BOUNDARY SURVEY OF
LOT 11 AND LOT 12 EXCEPT THE WESTERLY 48.00 FEET OF LOT 12, BLOCK 61, ATLANTIC BEACH,
AS RECORDED IN PLAT BOOK 6, PAGE 1, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED TO:
ROBERT B. BOENEKE & DEMORY BOENEKE
SUNTRUST MORTGAGE, INC + j
AMERICA'S CHOICE TITLE COMPANY t5-
CHICAGO TITLE INSURANCE COMPANY
"I SPd
ATLANTIC OCEAN +
! (B Ew04 )
i( 50 .00' (D EED) (4, ,
(` N 03'35'40" W`
J 49 •88' (MEASURED)
•
INIMEN v
�� --\1;1,...— . —
EAST 152.00' 1 LOT 11
De-,D � OF 100 12 ��
r W BLOCK 61 I 21'
.,,..,,O__ff, to
°�
t 0
[V , 1 Q 1 -
in V
iaY
O
d 7,:///
~� 2.2' L
OF
W — _ _.. — .. �..
FLOOD_ OF LOT 10
N
CO a � ft r ,wFR0 AI E BLOCK 61
Tn ~ 2 O' `T 1 ON
fh .4 := O W I LOCATION
ZONE 'x'
to— � IIIIIII� $ c aL-I $ • ,PAIL
co Z X
o `� w
0e09 S ROMP . 6
i
- •, -
I& r n fi '�` .fi = •
(L -1) -1.5 p t
N83'27'28 "E l � Z A�' 0 4 2011
Ic 48.04' (MEASURED) �� .
48.00' (DEED) o.r I r na
i.
PARtEAti OF N 03'50'38' w •. ! •1 I.F & COASTAL SYSTEMS
EM
24.96' (MEASURED) g .) I :. ' Z '
' 25.00' (DEED) 9 I �
1.0• 1,
"N ,.
16146 i:l agE
aOOt 25-00r mix°
coesta 2.5.ar 0EAsuRE0) N 0350 W
24.91' (MEASURED)
/�" PSM LEGEND: 25.00' (DEED)
o - STRIPED 16146 PC - PUNT OF CLIAvATOTE
F gN6 1 2 I RdI PPE PT - PONT CF TANGENCY �1
•
NO T64CATI0N NNE O
PUNT Of RED w �r
(UNLESS 0IiER1YSE NOTED) OY F CURVATURE /U'y- O ..2 /J V/ly
■. .'.4 CONNED NONNENT PIM - PONT CURVATURE OF =WEANS BEACH AVENUE
A/C + AIR C0Na1TI0nER
—0— : FENCE 0 - CONCRETE (40 RIGHT OF NAY)
Ray Thompson REVISIONS
SURVEYING, Inc. DATE DESCRIPTION
r I / JI11R !Going the DISTANCE for YOt4 J iMq ke
1 111 4613 Philips Highway, Slim 210 It I �/�
■ 1 Rains Jacksonville, Fladda 32207 TITLE- -- G Q.11IPd 1V"7l
If f MUIR ( B)904- 446 -5125
(Fax) 904 -448 -5178
JOB # 18790 I DATE OF FIELD SURVEY: 2 -4 -2011 I SCALE: 1" = 30'
NOTES: CERTIFICATE ., T
1: BEARINGS ARE BASED ON TIE ALSSU Q BEARING OF - -3_(1 Y28'_SY_ -- 1 HEREBY CERTIFY THAT TH. ;,/ ,.,. IRAN , y - `� -• a' MY REW0N5BLE CHARGE
ALONG THE SOUR -M9.7 BOUNDARY ENE OF SUBJECT PARCEL. AND MEETS THE MINIM ,o. STAN• . C., SET NINTH BY 11E FLOR0*
2• BY GRAPHIC PLOTTING ONLY THE CAPi10NF0 LANDS LTE WAIN (ROOD 20HE BOARD OF . `.. .. /. /'',EY ES. 016 1 CHAP" 60017 -6. FLCWDA
___](y An ' AS SHORN 11N THE NATIONAL FLOOD INSURANCE MAP, AnWa"TA1104 •• MIT TO SECTION 4 DA STATUTES.
OMEN). AMR_ A l7, 19a9, COMMUNITY NUMBER: 120075 PANEL .Q. •
3: THIS SURVEY REFLECTS AU. EASEMENTS Q RIGHT OF WAY AS PER RECORDED t _ _ _„„(.4,17 PLAT 8/8R TIRE COMMITMENT IF SUPPUEO. UNLESS 0THETWASE STATED, MO T. TM� tY �-�
01HER TITLE VERIFICATION HAS BEEN PERFORMED BY THE UNDERSIGNED_ 41
4- THIS SURVEY IS NOT VAUD 4171101./7 AN AUTHENTICATED ELECTRONIC SIGNATURE REGISTERED 5UR MAP' `6146 STATE OF FLORIDA
MO AUDENTICAIED ELECTRONIC SEAL. 7) 7469
7 iP.iii� .
LAND SURVEYS 0 CONSTRUCTION SURVEYS 0 SUBDINSIONS
MAP SHOWING BOUNDARY SURVEY OF
LOT 11 AND LOT 12 EXCEPT THE WESTERLY 48.00 FEET OF LOT 12, BLOCK 61, ATLANTIC BEACH,
AS RECORDED IN PLAT BOOK 6, PAGE 1, OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
CERTIFIED T0:
ROBERT B. BOENEKE & DEMORY BOENEKE
SUNTRUST MORTGAGE, INC
AMERICA'S CHOICE TITLE COMPANY
CHICAGO TITLE INSURANCE COMPANY
ATLANTIC OCEAN
J , 50. (DEED)
N 0335 ' 40 ' W
9 49.88' (MEASURED)
, 9, 25.00• (PLAT) 1 25.00 (PLAT) • y
wAU I
r/
. , ,,,,.....i, ik „
�, AST OT 12 ' I LOT 11
_q� - y OF LOT .0 i ' ///
r - 1 4 $i+.' { � 12 BLOCK 61 BLOCI( 6/ m , `yG�. ,
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o N 1 1 I EC IAI
0. .nN ', W a J(,
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S ° :', ,.... ' i 44—
APPROONAIE
W 3
W b no c+w.! — _ I ) _ FLOOD LOCATION LOT 10
a = — r o ONE p ; } BLOCK 61
N
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(L-1) '
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N 83'27'28" E ; I r wooD �ar l�;�s e `
48.04' (MEASURED)
48.00 (DEED) 0.9 1 Y T\ /'
(L -2) , \ /
N 03'50'38" W o ;.� j v i (pi
24.96' (MEASURED) $ d 9".
25.00' (DEED)
1.0•
* N ome 57 '1
(RAT)
� ,
25.00' , ::,:..3.,..- '
CORNER 2500 .f (MEASIMED) N 03'50'3$" W f vi '
24.91' (MEASURED) )
. e) (..-4
L 2500' (DEED) / tik
O - SET ,/r REBAR PC s PONT OF CURVAIUPE • J..
STAMPED P• PIPE - PONT of TANGENCY � j �
• _PNPE
NO PRC - J R V T U RE,fRSE 'y �
(UNLESS O NTP WON PS OTH€R 7IERMSE SE NOTED) ONNATIRE E� ✓�
■ - 4 ,.- TE MDIAAENT POD .. PONT ATURE °'°O141 BEACH AVENUE / ,
A/C - AP F NC ENCE i1011EiN O - CONCRETE (40' PoOIT OF WAY) {.. '
—lc— - F
Ray Thompson REVISIONS
.r ■� i m _.-- ...... DATE DESCRIPTION
1 SURVEYING, Inc - {
• ��� ICaoiE18 the DISTANCE *3r Youl eric choke
1 I /MIN 4613 Pleas Highway, Suite 210
it �� �r++�
j • I �: , 32207 TITLE COMPANY (Phone) 904-448-5125 ,
(Fax) 904-448 -5178
J08 # 18790 I DATE OF FIELD SURVEY: 2 -4 -2011 I SCALE: 1" = 30'
NOTES: CERTIFICATE 11
I: BEARING , A& S ARE BASED ON THE 4 HEARNO or __ - _W___ I HEREBY CER TIFY THAT J; X (N01 - ..I' MY RESPONSIBLE CHARGE
ALONG 1HE SOUTHERLY BOUNDARY UNE OF SUBJECT PARCEL AND MEETS TIE MNR41Y ST -•:. SET FORTH BY DE FLORIDA
BOARD CF • - • �` • . [,' ' 6Np M "� CHAPTER 61617 -4 FLORIDA
2: BY GRAPHIC PLOTTING ONLY THE CAPTIONED LANDS UE WITHIN FLOOD ZONE ADMNIS1RAByE ,,, / � - • : ANT 0) SECTION . " p •' •A STAMUIES
____:._E_&_613_7_____ AS SHOWS ON THE NATIONAL FLOOD INSURANCE MAP,
DATED: APRIL 17, 1989. COMMUNITY NUMBER: 120075 PANEL _OW L& .
3: THIS SURVEY REFLECTS AU. EASEMENTS & RIGHT OF WAY AS PER RECORDED _ t t f �_��
PLAT E /OR TITLE WI
E COMMITMENT IF SUPPLIED. UNLESS OTHERWISE STATED, NO AYMAVDET710MP'•
OTHER TIRE VERIfCA1ON HAS BEEN PERFORMED BY THE U NOERS G NED. - ' -
4: THIS SURVEY IS NOT VAJD 1RTHOUT AN AUTHENTICATED ELECTRONIC 9GNAIURE REGISTERED - k . • VD MAPP. -. :146 STATE OF FLORIDA
AND AUTHENTICATED ELEC1RONIC SEAL • U.. �• �- -- ,f • 7469
LAND SURVEYS 0 CONSTRUCTION SURVEYS 0 SUBDIVISIONS
Doc 8 z01104, '4zs5
NOTICE OF COMMENCEMENT
'umber Paces
Recorded 03 02 2011 at 10'17 AM.
JIM FULLER CLERK CRC! iT COURT DUVAL
Permit No. COUNT'!
Tax Folio No. RECORDING $10 00
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Section
713.13 of the Florida Statutes, the following information is provided in this NOTICE OF COMMENCEMENT.
.1)escnptuxt of property (legal description): ° " ♦ /. 4/ CiO , ,
a) Street (job) Address: "r �';jj�;��f�►i=' dill111.111111111P►
2.General description of improvements: WINII /"Z
3.Owner Information �7
a) Name and address: // ,- 70.3 C /4 f 3 2J 3'
b) Name and address of feesimpletitleholder (if other than owner)
e) Interest in property < +f.2' d/
4.Contractor Information
a) Name and address: , �cl \ c iv,-; \-J-v.\ rurej...� i " ) �LC �.0. ¶,,•: 14"
I))
b) Telephone No.: - i- ,`t ti Fax (Opt.) ` - `�'� 1c�
\ \ 5.S urety Information
t a) Name and address:
b) Amount of Bond:
c) Telephone No.: Fax No. (Opt.)
6.Lender
a) Name and address: Al/ `/"`
Phone No.
7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
al Name and address:
h i I elephone No.: Fax No. (Opt.)
Sin addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes:
a) Name and address:
b) Telephone No.: Fax No. (Opt.)
9.Expiration date of Notice of Commencement (the expiration date is one year from the date of recording unless a different date
is specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13,
FLORIDA STATUTES, AND CAN 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 YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
STATE OF FLORIDA
.
.
10 COUNTY .:r• __......__..
CUUNTY OF PINELLAS - ,
Signature of Owner or Owner's orized Officer/Director/Partner/Manager
eo
Print Name
fhe foregoing instrument was acknowledged before me this • > day of ., 4 , 20 , by
as • - . . • (type of authority, e.g. officer, trustee,
\ 5 \MP / b4
attorney in fact) for JQN. 4name of party on behalf of whom instrument was executed).
i '
Personally known OR Produced Idert t at m Mtiop& Signature { a ,' f ,;''r. ,° :,._
Type of Identification Produced • • � .0
q6 5 , � • tt(t (pr c � ; d .< ' ' ' ° j ,I
• • � i :o `�
Verification pursuant to Section 92.525, F1or ig, 1"-X � �' alties of perjury, I declare that I have read the foregoing and that
the facts stated in it are true to the best of my kn e 4■�a ef.
11!1111 �.
FOK CIS /Ni )('1, •LUI
Signature of Natural Person Signing (in line # 10.) Above
.BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
80() Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845 r----,-,---------
14
Permit Num*
-q.‘,. t 4
c.) A- ... At-q`'./ .12'
c.A.-- Parcel # Li '' .-47 t 7" • 11 " - I 6 7
', ,
.
or . rea o : "q.. t.
..,?5-3-6 .
, ,AlUkt' on of Work S Proposed Work heated/cooled n r ; ?, d/cooled
i
- .,-- - •,Y,, '--; ::ircie one): New Addition Alteration Repair Move Demolition pool/spa window/door
:,:i- 4 yxistinglproposed structure(s) (circle one): Commercial
is a fire sprinkler system installed? (Circle one . es No N /A
• ' - •, ') -,,', "\nproval ;
, ., _:itJp:,_ i •A - odLets use product apf7r701711TorMai
0 , _
: i the type of work to be performed, (-_-_ .. \(:)\-- -
' c:' 1 1-1 \e-:,a,\Aci\- . )
picie-„
_ _..... _
information:
/‘ Address: 2c/L23 c -
Sta4ZifY•_.3-1k,/ Phone
.liCif filatiOn:
• ■ .
• , u1:11 tiL, '■•• iNitiflC a e itt ' ,..-21-c CA' \ Qualifyin a Agent
_.....
_
ANIMM . C ./ ity . State L• - ,- 2 Ke_,..?
— — -- rdr i S w r '
;2.--%"?,7 7 Job Site/ Contact Number *J • Fax #
onli egistration ii i
,.-: . • . Pot•le .... . .. .._ „._ .„_. .„ . _ _
,.. . • ';:': X:: Phone At
:der Name and Address
_____ ........_ _„...... ._...
1,(:i:... ( ,:npany Name and Address
Name and Address
_ ...,
ik,ich made to obtain a permit to do the work and installations as indicated 1 cert6 that no work, or installation has commenced prior to the
Oer i ni 1 and that all work will be perfbrmed to meet the standards o/ all laws regulating construction in this jurisdiction. This permit becomes null
hi , oi,' rt 1'),..1, .;' not commenced within six (6) numtlis or 2:leans:ruction or work is suspended or abandoned/Or aperiod of six (6) months at any time after
11,1610 that separate permits must he secured lor Electrical ;York, Plumbing, Signs, Wells, Pools Furnaces, Boilers, neaten,
?•,/,,',7< ,,,,::' ,i.p er:9nditioners, etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
.• '' . ;::'EM.ENT MAY .RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
R PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH
ENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
,,.., .- ii ..,1 :, th.,,, read and examined this application and know the same to be true and correct. All provisions (paws and ordinances governing this
■I'lli ;V complied with whether specified herein or not. lhe granting of a permit does not presume to give authority to violate or cancel the
, ol any aiher federal. state, or local law regulating cons fiction or the performance of construction.
;00 ..... _
.A
40
Signature of Contractor
..........„
—
_.
/ . ‹.--"074/4E)
/ , .
Print Name l e,6p.x. ) ...' • \Af...
.......... .
...,: ,,:.„„,<„,,,,bed before me Sworn to and subscribed before me
.,. 14 .,:,:, .00 , 20 .i.f this V.L Day of , (. , 20 k
„- N p, SIMp/ i
K --- - Aq4y-tSA,_
, i *•).' • .. 1 .**•.,%) ....c,,, . --- . --r,ei" " ..---
s' t Th.) 1 i IC ..** •
47 : • cS OA 20 ep'. 1:- Notary Publie --- - 7 — ----
– • # 4- ‹,‘ • I.--
.---.. :,..-,- -, CP • •••
= ; "' • * =
Revised 01.26.10
• :*:-...-
st....0.:
*DD 965126 z . ._. . .
--, o •
- % 4 % aondett -Z... . •kli 44, ELIZABETH ANNE LANOILLE
3*: ' ,7. •*: MY COMMISSION 9 DO973752
* A ....
• it,„,0,,,0". N : EXPIRES March 22, 2014
(407) 398-0153 FlotidallotaryService.com
PIOiEtT10M
4 0 1*
, � ` � - FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
• Bureau of Beaches and Coastal Systems
_ 3900 Commonwealth Blvd — MS 300
FLOR A Tallahassee, FL 32399 -3000 Permit Number:
(850) 488 -7708 No. of Pages Attached::
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 conaidared by the staff designee of the Department of
Environmental Protection and found to be in compliance with the requirements of Chapter 62B -33, Florida Administrative Code (FA.C.).
specifically limited to the activity in the stated location and the Any special
specifically
by project description, plans (if attached standard conditions, and specie) l
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.
PROJECT LOCATION:
PROJECT DESCRIPTION:
•
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 urunediately upon
issuance and shall remain posted along with local approval until the completion of any activity authorized by this permit. Other
permit include: conditions of this
STANDARD PERMIT CONDITIONS: The permittee shall comply with the attached standard field pentad conditions.
APPLICANT INFORMATION: I hereby certify that I am either: (la) the owner of the subject propaty g (1 b) I have the owner's consent to same
this permit on the owner's behalf, and that (2) I shall obtain any applicable licenses or permits which may be required by ®decal, *te, county, or municipal
law prior to commencement of the authorized works (3) I acknowledge that the authorized work is what I request* and (4) I accept responsibility for
compliance with all permit conditions.
Applicant's Signature Date Telephone No. ( )
Applicant's Printed Name Address
If applicant is an agent /
printed nacre of property owner property owner's address property owner's telephone no
DEPARTMENT FINAL ACTION AND FILING AND ACKNOWLEDGMENT: This field permit is approved on behalf of the Depart ne nt of
Environrsental Protection by the undersigned staff designee, and filed on this date, punning to section 120.52, F.S., with the undersigned designated
Deputy Clerk, receipt of which is hereby acknowledged.
/ /
Staff Designee/Deputy Clerk Printed Name ofDesignee/Depuy Clerk Dare
PUBLIC NOTICE IS ON THE BACK OF THIS PERMIT. EXPIRATION DATE:
permits issued pursuant to Section 62B -33. 014, FA.C., are valid for no more than ninety days and other fidd permits are valid for no more
than 1 months. The staff designee may specify a shorter time limit)
EMERGENCY PBRM1T: 0 YES 0 NO AppoVid plans are attached: OYES D NO
AND PUBLIC NOTICE CONSPICUOUSLY ON TILE SITE
DEP form 73-122 (Updated 01106) Mite Copy-Tallahassee Office] (Yellow Copy- Applicant] Pink Copp-StayfDesigreeej