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Permit Porch Additon 1982 Sevilla W 2012 ` CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD "' r) ATLANTIC BEACH, FL 32233 ti INSPECTION PHONE LINE 247 -5814 Application Number . . . . . 12- 00000434 Date 5/16/12 Property Address 1982 W SEVILLA BLVD Application type description RESIDENTIAL ALTERATION Property Zoning TO BE UPDATED Application valuation . . . 17500 Application desc SCREEN IN AND INCREASE SIZE OF ENCLOSURE Owner Contractor ARIEFF, DAVID LIFETIME ENCLOSURES, INC. 1982 W SEVILLA BLVD 5521 CHRONICLE COURT ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32256 (904) 731 -5580 - -- Structure Information 000 000 ENLARGE EXISTING SCREEN PORCH ENCLOSURE Occupancy Type RESIDENTIAL Permit ELECTRICAL PERMIT Additional desc . INSTALL 4 OUTLET /SWITCHES Sub Contractor . AMERICAN ELECTRICAL CONTRACTOR Permit Fee . . . 57.40 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Expiration Date . 11/12/12 Special Notes and Comments 2010 FLORIDA BUILDING CODE, 2008 NATIONA1 ELECTRIC CODE *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. *SUBMIT "CERTIFICATE OF COMPLIANCE" BY A LICENSED PEST CONTROL COMPANY PRIOR TO C.O. Roll off container company must be on City approved list and container cannot be placed on City right -of -way. Other Fees STATE ELEC DCA SURCHARGE 2.00 STATE ELEC DBPR SURCHARGE 2.00 Fee summary Charged Paid Credited Due Permit Fee Total 57.40 57.40 .00 .00 Plan Check Total .00 .00 .00 .00 Other Fee Total 4.00 4.00 .00 .00 Grand Total 61.40 61.40 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. ELECTRICAL PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd, Atlantic Beach, FL 32233 Ph (904) 247 -5826 Fax (904) 247 -5845 JOB ADDRESS: 1982 SEVILLA GARDENS BUILDING PERMIT # 12 -434 JEA INFORMATION REQUIRED ON ALL PERMITS 200 AMPS Alt) VOLTS .4i15 /� PHASE VALUE OF WORK $ NEW SERVICE ❑ Overhead ❑ Underground ❑J Underground up Pole ,_!Residential (Main) Service 1 0 - 100 amps 101 150amps 1 1 151- 200amps 1 I amps # of Meters Commercial (Main) Service 0 -100 amps [ 7101 150amps 1 1151- 200amps 1 amps 1 CT Service amps Conductor Type Size 'Multi-Family (Main) Service 10 -100 amps 1 101- 150amps 1151- 200amps I amps # of Unit Meters Temporary Pole C! amps SERVICE UPGRADE I 1 amps 11 CT Service amps NEW FEEDER (ADDITIONS, ACCESSORY STRUCTURES, ETC.) l 100 amps 1 1150amps 1 1200amps 1 I amps 1 ICT Service amps ADDITIONS, REMODELS, REPAIRS, BUILD -OUTS, ACCESSORY STRUCTURES, ETC. Outlets /Switches: 4_0- 30amps 31- 100amps 101- 200amps Appliances: 0- 30amps 31- 100amps 101- 200amps A/C Circuits: 0- 60amps 61- 100amps Heat Circuits: # circuits @ kw Number of Lighting Outlets, Including Fixtures: OTHER ELECTRICAL PROJECTS Swimming Pool 1 1 Sign 1 I Smoke Detectors Qty Transformers KVA I Motors hp FIRE ALARM SYSTEM (Requires 3 sets of plans & Fire Alarm Checklist) Qty volts /amps VALUE OF WORK $ REPAIRS/MISCELLANEOUS I Replace Burnt/Damaged Meter Can I 1 Safety Inspection ,_1 Panel Change 110H to UG l Other Wire Screen Room 6 / V , q Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction. Property Owners Name David & Susan Arieff 372 -0335 Phone Number Electrical Company American Electrical Contracting, Inc Office Phone 737- 7770_Fax 737 -1099 Co. Address: 5065 -3 St Augustine Road City Jacksonville License Holder (Print): Earl W Fric State Cert 1 .tio egistration # ER0015316 Notarizet4Signry(> I,p, p8 Oder /.z /A- mm #DD = ,, �nV "iJ' Co . Expires 112512 Sworn and subscribed befor- me th's 16 day of 12012 ^`` '" ota Assn., I nc - `,' _c�;:' Florida N ry \\Signature o f Notary Public r'' F` "� ..v - y J► ��✓ IP �t ►'"lt1r . 1 CITY OF ATLANTIC BEACH j 800 SEMINOLE ROAD !J = ATLANTIC BEACH, FL 32233 - INSPECTION PHONE LINE 247 -5814 Application Number 12- 00000434 Date 4/23/12 Property Address 1982 W SEVILLA BLVD Application type description RESIDENTIAL ALTERATION Property Zoning TO BE UPDATED Application valuation . . . 17500 Application desc SCREEN IN AND INCREASE SIZE OF ENCLOSURE Owner Contractor ARIEFF, DAVID LIFETIME ENCLOSURES, INC. 1982 W SEVILLA BLVD 5521 CHRONICLE COURT ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32256 (904) 731 -5580 - -- Structure Information 000 000 ENLARGE EXISTING SCREEN PORCH ENCLOSURE Occupancy Type RESIDENTIAL Permit RESIDENTIAL ALT /OTHER Additional desc . Permit Fee . . . 140.00 Plan Check Fee . . 70.00 Issue Date . . . Valuation . . . . 17500 Expiration Date . 10/20/12 Special Notes and Comments 2010 FLORIDA BUILDING CODE, 2008 NATIONA1 ELECTRIC CODE *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. *SUBMIT "CERTIFICATE OF COMPLIANCE" BY A LICENSED PEST CONTROL COMPANY PRIOR TO C.O. 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 2.10 ENG REV BLDG MOD OR ROW 50.00 ENG REV PRE APP > 3 HRS 25.00 STATE DBPR SURCHARGE 2.10 UTIL REV PRE APP >3 HRS 25.00 Fee summary Charged Paid Credited Due Permit Fee Total 140.00 140.00 .00 .00 Plan Check Total 70.00 70.00 .00 .00 Other Fee Total 104.20 104.20 .00 .00 Grand Total 314.20 314.20 .00 .00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. BUILDING PERMIT APPLICATION I ; 1--7-�� D� � i Li Li , CITY OF ATLANTIC BEACH 800 Seminole Road, Atlantic Beach, FL 32233 APR 1 2012 Officeg 4) 2 ax (904)12,47-5445 t__ i W _ t 9 Job Address: 2_ �� 0— Permit Number: — 4i' ' 9 Legal Description S »A, \X,C 'k C- races . W■.■ V Parcel # t LQ. 4l4. 2' O L i i 0 Floor Area of Sq.F't. Sq.Ft Valuation of Work $ t l .1S Proposed Work heated /cooled non - heated /cooled Class of Work (circle one): New Addition Alteration Repair Move Demolitio k .. • bt/ a /door• -• -., Use of existing /proposed structure(s) (circle one): Commercial Residential I � , FILE If an existing structure, is a fire sprinkler system installed? (Circle one): Yes No t.1'. A ' . Florida Product Approval # }: l copy For multiple products use product approval form Describe in detail the type of work to be performed: 1 • LQ K Z Cie-..e AL N..) ry\___ Property Owner Information: CO _k If / //, £ /v Name: \AU Address: ilea S - - • _ S City ( Y�- �'tL'•'��'L��_�'? StatFL.Zip - J2233Phone 9 i " E - Mail or Fax # (Optional) Contractor Information: LOrtne Farfa wrs, Its Company Name: 5521 anent feCt. Qualifying Agent: J.e_ � 1 *_-.r Address: sd(iae322% City State Zip Office Phone 9 /. vikJL ' O 7 9- Job Site/ Contact Number Fax # State Certification/Registration # (..4..C., O .S - 1 Architect Name & Phone # Engineer's Name & Phone # Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and 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. 1 understand that separate permits must be secured for Electrical IFork, Plumbing, Signs, Wells, Pools, Furnaces, Boilers, Heaters, Tanks and Air Conditioners, etc. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT 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 YOUR NOTICE OF COMMENCEMENT. I hereby certify that I have read and examined this a placation and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to wive authority' to violate or cancel the provisions of any other federal, state, or local law regulating construction or the performance of construction. A r. Signature of Ow er1 . ■ '` s�i;d/ Signature of Contractor /Mi � ,... Print Name 4`, CN f i e.- Print Name ,� � AMY GOODWIN J�" / �' AMY GOODWIN Sworn :.n. subscr Tall* - + :� w ' n tri� State of Florida f. this Dary of �"" '.�'f ota Pu - state of Vr Sworn' • a t may - ��i -, � g i �g� this ,, D • .4 � � i '' am. Expires Jun 8, 2013 • ,p . Alitt 4 `:; g Commission # DD 897288 �;r Commission # • • • •: iir l ational Notary Assn. ►i Jc]hrough National Notary F Notary u. Notary Pug is Revised 01.26.10 ff ?IJ E _C OP Y1 F. . . ,,.,,,,, ,... . r tea. „- A v4a' + .`wt+ tc a y. R4 AFFIDAVIT FOR ATTACHING A NEW STRUCTURE TO AN EXISTING STRUCTURE • TO: Buyafidirr aection Division, Cit of Jacksonvill l41 North Hogan Street 1-1 0171C Owner: - i s .4- V Ltd an . iSiame v lc? g , PN LS e d I . 7 ardeci Ls .Slr ' c re.sw ilv. State nc17_ip Cocle Li Enclosures, D. Contractor; • 5521 CFironicC&Ct. yacksonvdt' F1 3225 Permit Number B - /d-- 3y As the Contractor for the proposed new structure located at the above address, i have personally viewed with the above named home owner those portions of the existing structure on NVIIICI1 portions or the proposed new structure are to be attached for sinuctural support. I am confident that the drawings an.cl details • included with this permit application depict the existing conditions of the host stricture, and the members of the existing stnleture upon which the new structure are to be attached are sound with no rot or deterioration The home owner has been advised by me that, in my best judgment based on experience and knowledge of structural adequacy, the members of the existing structure Upon which the new structure are to be attached are sound with no rot or deterioration and will support all structural loads and forces imposed on them. By signing below, I hereby declare that I will hold the Cily of Jacksonville harmless and release ii from any responsibility and liability for any adverse consequences or failures resulting from this work, and further that I will not initiate execute or enjoin any legal action against the City of Jacksonville for such consequences or failures. . A cops' of this document will he recorded as an official record with the Building Inspection Division permit history so that any and all future buyers /owners oi'this property may be made aware of the status of work performed on this structure. G000WIN Si - I �_��- f { � -- Dale / ! — • Before me .i. ' f l(2 day of L A / ('Ll CJ �`� II In the County of Duval, State of Flor has prosa> a 5 " AMY s s,p „ , P,,. AM ' Notar Public - St Q Florida . AfIirn i statement a d declarations here i/t`F ild e£Ilitlig 'on # DD 897288 „( .. ,. \\ Lf Fl „ _., „,, ,_ ' : „.. � Bonded Through National Notary Assn. Notary Public at arge, 5.1—ate of r7.— , County of 0,-4-c, o--- Personally Known t/ or Produced Identification ID Type HOMEOWNER SUNROOM ENCLOSURE AFFIDAVIT ,:,;' , ..,-.v4,9,,,,..„ ,.: .,,„,.....,,,;: , ...„ .. ti,..,,, ,,, CO PY The purpose of this document is to make you aware of any limitations in the enclosure tha't`1S being permitted at your ,J y residence. The table below, Sunroom and Screen Enclosure Requirements provides a brief description of the various sunroom category requirements. There may be restrictions on the use of your present home depending on the category of sunroom you are installing. The property owner is hereby notified that should any form of temperature control system be added to a Category I, II, or III Sunroom or the removal of the doors separating any Category I thru IV Sunroom from the host structure occur, the room shall become non - compliant and must comply fully with all of the requirements for habitable /conditioned spaces as mandated by the Florida Building Code, The Florida Model Energy Code and State Statutes. OWNER I have read this complete form and understand I am receiving a Category Sunroom. (I -V) Printed Name Da NA e`, Ac Address I cAt a 5c v� C-- C • Signed-1 I LI %/ Date: / / Before me this d ay of _ ,u∎Iiu,, - rsonally appeared ,,, rav P0 6 , AMY G00DWIN 1 ms's * ' . Notary Public - State of F • • . . herein by himself/herself and affirms all statements and declarations herein are true and accurate. - • �' i = My Comm. Expires Jun 8, 2013 ' pf omission # DD 897288 Notary Public at Large, State of P-` County of 'Ili cuph National Notary Ao4 t. Personally Known ❑ o r Produced Identification ❑ ID Type Sunroom and Screen Enclosure Requirements Category I 11 Habitable I 111 IV V Space No No No Yes Yes Foundation Walls <200pIf can Walls <200pIf can Walls <200pIf can Walls <200pIf can Walls <200pIf can have 8 "Wx12 "D have 8 "Wx12 "D have 8 "Wx12 "D have 8 "Wx12 "D have 8 "Wx12 "D ftg or 3 -1/2" stab ftg or 3 -1/2" slab ftg or 3 -1/2" slab ftg ft if no concentrated if no concentrated if no concentrated ftg load >7501b load >7501b load >750lb Exit Lighting Not Required Required Required Required Required Interior Electric q Outlets Not Required Not Required Not Required Required Required Emergency Egress from exist. Egress and Exit Egress and Exit Egress and Exit Egress and Exit Escape structure allowed must meet code must meet code. must meet code. must meet code. Openings if open to Other resistance Other resistance Other resistance atmosphere or requirements for requirements for requirements for considered forced entry, air forced entry, air forced entry, air screen enclosure leakage and leakage and leakage and and has screen water penetration water penetration water penetration door leading also apply. also apply. also apply. away from residence. Misc. Window Host structure Removable Removable Host structure Host structure and Door windows /doors windows allowed windows allowed windows & doors windows & doors Requirements shall not be in sunroom. Host in sunroom. Host shall not be may be removed. removed. structure structure removed. windows /doors windows /doors shall not be shall not be removed. removed. Wind Borne Debris Opening Not Required Not Required Not Required Required Required Protection Energy Sheets Not Required Not Required Not Required Required Required Doc # 2012083407, OR BK 15914 Page 2340, NOTICE OF COMMENCEMENT Number Pages: 1 Recorded 04/17/2012 at 01:38 PM, JIM FULLER CLERK CIRCUIT COURT DUVAL COUNTY Permit No. RECORDING $10.00 Tax Folio No. 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. I.Description of property (legal description): \' S v (A, S '2._. a) Street (job) Address: ete - st)sA c;L„U,L5 2.General description of improvements: ''�. Li? I '�L,r \ nr1 3.Owner Information a) Name and address:DaMa r t er-F tci fi 2 ' 11a. al .ix- --1 S b) Name and address of fee simple titleholder (if other than owner) c) Interest in property 11p 4.Contractor Information a) Name and address: b) Telephone No.: 7„,, 14sS t ax No. (Opt.) ne l - •5 - 1S"0 5.Surety Information 552,1 Ofronith Ck a) Name and address: 9 , , . 7,77.3.2256 b) Amount of Bond: c) Telephone No.: Fax No. (Opt.) 6.Lender a) Name and address: Phone No. 7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served: a) Name and address: b) Telephone No.: Fax No. (Opt.) S.In 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 ofNotice 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 C •'' ' ' - • ' ' ' ' • G YOUR NOTICE OF COMMENCEMENT. AMY G000WIN sT. T B ..9 i bA Not. . Pubic - gte of Florida r co Or - Jun 8, 20.13 10. &:�; `,..,-,Y. t on" '. # DD 997288 Signature o caner or Owner's Authored Officer rector /PartneriManager e " ti„ i" 9on� � ;,g f , n. Notary Assn. DA i ..o ff ,9 le / e ', Print - Name / • The foregoing instrument was acknowledged before me this 7 day of I .220 a by as • • e of authority . e.g. officer, trustee, attorney in fact) for (name of pa , on b • hp in / ument was executed). Personally Known OR Produced Ide . fication I Notary Signature _ �_ r °r / Type of identification Produced D� Name (print) /W pursuant to Section 92.525. OR , , e s Verification P 5. Florida Statutes. Under penaltie of perj ., , /decl e g r4i.ye read theAlt eCO*Wi lyd that the facts stated in it are true to the best of my knowledge and belief. / ; : °. ,..!•`: „,, Notary Public - State of Florida � � i \ .. . � ,,F U o `= My Comm. Expires Jun 8 2613 ` ` FORMSMOCresd201u Commission # DE: e) 7288 Signature ii 5 Person Sign s , . - • i • AFFIDAVIT FOR ATTACHING A NEW STRUCTURE TO AN EXISTING STRUCTURE TO: Bi • • ) ection Division, City of Jacksonvill ) 14 North Hogan Street Home Owner: 1a Nome g Seat araleci t S'Ir'e ress • 'itv. ,S'tate - nrl7_1/) Code L>i eNmt �}I Chstt�s, Inc. Contractor;. 5521Chrotticle yak FL 32256 Permit Number B- - As the Contractor for the proposed new structure located at the above address, I have personally ' icwed with the above named home owner those portions of the existing structure on which portions of the proposed new structure are lobe attached for stnnctural support. I ani confident that the drawings and details - • included with Otis permit application depict the existing conditions of the host stntcture, and the members of the existing structure upon which the new structure are to be attached are sound with no rot or deterioration The hone owner has been advised by me that, in my best judgment based on experience and knowledge of structural adequacy, the members of the existing structure upon which the new structure are to be attached are sound with no rot or deterioration and will support all structural loads and forces imposed on them. By signing below, i hereby declare that t will hold the City of Jacksonville harmless and release it from any • responsibili and liability for any adverse consequences or failures resulting from this work, and further that I will not initiate, execute or enjoin any legal action against the City of Jacksonville for such consequences or failures. . A copy of this document w'ili be recorded as an official record with the Building Inspection Division permit history so that any and all future buyers /owners of this property may be made aware of the status of work performed on this structure. Signed Date Li / / � 1 / C i • Before me t lU day of �` � C 2 :t (_l` — ' t 3 1 6 /1 in the County of Duval, State of Flot has ��b ► aafi� . o",`� n AMY GOODWIN s Not ll` 11 tic - State of Florida a � .� f * * ` ' 9 113. TI�L•i�111�tr5 ibed s j 3a t d Affirm al statemen Oa d dec arations here ::f t iul �a�l li��ton # DD 897288 r • t " ....r Bondi Through National Notary Assn. 00 str a y = . Notary Public at arge, to of )Z- , County of Personally Known V or Produced Identification iD Type City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) pp( 800 Seminole Road /72 - ()1/3 `-[ � ._ x ' Atlantic Beach, Florida 32233 -5445 lkiW Phone (904) 247 -5826 Fax (904) 247 -5845 E -mail: building- dept@coab.us Date routed: /3// City web -site: http: / /www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: / 9 f2 "' f L �� /a"' �" � " ? G, Department review required Yes No / 'Suilding Applicant: ,,Z , � T � C� / ) tSZt' r :4' anning 8 Zoning �lAdministrator Project: 7 Lry x � �1 C� c Etg' _Public Works •tic ' r7 2nCt 1 Public Safety eri7i, Fire Services r, JC 4 51 — i r) G ywol 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: Approved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by: _ Date: TREE *MIN. Second Review: Approved as revised. ❑Denied. P = j t ORKS � omments: TIL S � PUB IC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07!27110 ofar rf City of Atlantic Beach APPLICATION NUMBER , Building Department (To be assigned by the Building Department.) pp, lir if pi 800 Seminole Road /V - l 4 �. Atlantic Beach, Florida 32233 -5445 S jT4 " Phone (9 26 Fax (904) 247 -5845 �/ j E -mail: building-de ing- dept @coab.us Date routed: 7 City web -site: http:l/www.coab.us APPLICATION REVIEW AND TRACKING FORM s Property Address: l f / � � � � ` //J61'' / v `o Department review required Yes No c uilding Applicant: Z/F-il /7 £ / C tsZt :d',jnning & Zorn • T eeAdminis rator Project: ,, 4 6 -" Public Works`; r blic U ice. - 7 neI�� C� J Public Safety O t , n eriTe, ! ' Fire Services r�X1 rt . 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: � ' pproved. ['Denied. (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by: atikt-41 Date: 0 i /i 6/2 42_. TREE ADMIN. Second Review: ❑Approved as revised. ['Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07/27/10 City of Atlantic Beach APPLICATION NUMBER , , Building Department (To be assigned by the Building Department.) ' .- 800 Seminole Road j - 0 43 4 Atlantic Beach, Florida 32233 -5445 / "� Phone (904) 247 -5826 • Fax (904) 247 -5845 E -mail: building- dept@coab.us Date routed: /3 f City web -site: http: //www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: / ' / 9 f` /// J( /5/1/- r L ' � '� Department review required Yes No / C$uilding - :.. Applicant: i i � 7 /� � - n o /c &z I� j �Fl annin g , Zonir Tree_Administrator Project: 7 to x Gi JC/-- i 7 ion --'( Public Work � id�Ct.I ) ic Public S i � � P u bl Safety NineriTi rz Fire Services c:X Other Agency Review or Permit Required Review or Receipt Date of Permit Verged 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: Approved. ❑Denied. (Circle one.) Comments: BUILDING PLANNING & ZONING Reviewed by: Date: V TREE ADMIN. Second Review: Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: Approved as revised. ['Denied. Comments: Reviewed by: Date: I Revised 07/27/10 s - City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) r 800 Seminole Road k?' �/ 3 Atlantic Beach, Florida 32233 -5445 � `r Phone (904) 247 -5826 • Fax (904) 247 -5845 ,/ O r 1 3 r ! E -mail: building- dept @coab.us Date routed: '7 �City web -site: http: /lwww.coab.us APPLICATION REVIEW AND TRACKING FORM i 9/ Property Address: i�i//� //d G Department • rev required Y ie w requie No uilding Applicant: ,,/// E7 J k &Z4' / S _ anning & Zorn /- hq Tee - Admires ator Project: 2. (� x c� I JCrc C�1 � 6 0 — ( Public Works Public Safety 0 6 on erT TD Fire Services c 1 S'f1 n 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: proved. ❑Denied. (Circle one.) Comments: (L1LO PLANNING & ZONING Reviewed by: Date: 4 1 — 3 - / a TREE ADMIN. Second Review: Approved as revised. ['Den d. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: QApproved as revised. ❑Denied. Comments: Reviewed by: Date: I Revised 07/27/10