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366 Seminole Rd (vault) e ( CITY OF ATLANTIC BEACH PERMIT ,-;":5,.....A,T..,--:,.i\ APPLICATION # 1 BUILDING / ZONING DEPARTMENT? 800 Semino le Road 4 9 6 9/0 \�, V~ Atlantic Beach,Florida 32233 - (904)247-5800 "!r.).i 45 Fax (904)247-5845 RECEIVED www.coab.us JUN 2 7 2.007 APPLICATION TRACKING FORM BY: REQUIRED DEPT: Y N PLANNING 866 d:Ein,✓I�a J� O N BUJLDIFIG Pr®party Address: Z 1= igr N 'UBLI ■ •.=s O UBLIC UTILITIES Applicant: �5 effy)Cry✓ ©L � Y N FIRE DEPT. Project: c/eC(c.��-r- ,'r/C C.. Y N PUBLIC SAFETY w APPROVAL U o REQUIRED AGENCY: RECEIVED BY: INITIAL: DATE: w w Y N D.E.P HUFSTETLER 12 g Y N S.J.R.W.M. CARPER cc w _ Y N ARMY CORPS of ENG CARPER O Y N HOTELS&RESAURANTS HUFSTETLER APPLICATION STATUS CIRCLE ONE: SITE BUILDING DA AP REVIEW D BY: � 60 pAL: DATE: ,E, 0 1ST REV 0 I=• l_.V) 994.- I c7 PLANNING 0 1 0 1 2ND REV I ® I BUILDING PUBLI WO KS PU It I IES RE DEPT. PUBLIC SAFETY 0 0 1 3RD REV I ® I 0 I Return.this form to the I:baaiiaHb,.g Department once you have entered your comments into the AS400. CITY OF ATLANTIC BEACH PERMIT BUILDING / ZONING DEPARTMENT APPLICATION # Vrf 800 Seminole Road /� _ if 9// Atlantic Beach,Florida 32233 (/ • U ,1�� (904)247-5800 (904)247-5845 Fax www.coab.us RECEIVED JUN 2 7 2007 APPLICATION TRACKING FORM By: REQUIRED DEPT: 866 Q / Y N PLANNING Property Address: do �/I/d 1 /�-cJ z Ab N BU 11 G I= ffairigni-18" Applicant: 2)-0-il..5 ( Cry✓ E 2 DAMIllriuBuc UTILITIES` q Y N FIRE DEPT. Project: e1 /1 -7-e_ _!:a Y N PUBLIC SAFETY l co w APPROVAL FD o REQUIRED AGENCY: RECEIVED BY: INITIAL: DATE: w w Y N D.E.P HUFSTETLER Q � Y S.J.R.W.M. CARPER c4 Lii r.- I qd.,/0, _ ix Y ARMY CORPS of ENG CARPER 7 H Y N HOTELS&RESAURANTS HUFSTETLER APPLICATION STATUS CIRCLE ONE: SITE BUILDING DA AP REVIEWED BY: INITIAL: / DATE: O 0 1ST REV TA 0 (,J / 6. -i./t 7 £ /c:-?fr) '- p /0 ?ITT / C I lrc,t,.4."- Dr)v co, PLANNING BUILDING ® 0 2ND REV 0 0 WO PUBLIC UTILITIES FIRE DEPT. PUBLIC SAFETY O 0 3RD REV 4 Return this form to the Building Department once you have entered your comments into the AS400. r .-1 42 w 7 Aug 03 07 08: 09a C. ROGERS 904-2877584 p• 1 Dan 's Concrete Service Inc. Fax To: / Date: °c-- Company: From: 1/4./.___ /911/1/X Fax#: Ira ; Phone #: Subject: W 7440R0 # Pages (including cover) COMMENTS: /OCX R-- )41 e et/L.) /9- fip 12_0 74-( 7/71 -7ki, 1 . 939 Orangewood Road Jacksonville, Florida 32259 (904)262-1886(Telephone) • (904)287-7584(Facsimile) i t , � f 1,\,- 5 I r■i\, - 'INN. )46 ,v- 0 ' R. \ ' , '"-- __, . . • 0- .\,,,,. , "\Jv d ct 4 �, "() . 6 I'V■- 't '`!i., ti' G ,, 1 H - ,' ° . , i .\'_ . LA Q \t`k 1 _ c " 1 , -r'*-----' (I) � c 0 i r t t ""'`' CITY OF ATLANTIC BEACH 63 ' =' ' CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS 800 Seminole Road 904-247-5800 .--t-f.,i�r Atlantic Beach, Florida 32233-5445 Fax 904-247-5845 PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION. Date (1) ' j l PERMIT# Se m / iv© L ( ,/A ^ ISSUED BY THE CITY Job Address �? �Q l'f.1-, Permitee: 1�fl/VC. r 0rlt(2 cTl �e — - C,Telephone# , 3`7''6-e7// Permittee Address: ,a�f /°� �7- Requesting Permission to Construct: C... //iLC Ea A✓c� j ) (�/1� Y - t. 1V CA 2 f e— Location: (Reference to Cross-Street) Se / I h/a C'c. -/1.� 1. Applicant declares that prior to filing this application he has ascertained the location of all existing utilities, both aerial and underground and the accurate locations are shown on the sketches. A Letter of Notification was mailed to the following Utilities/Municipalities: Jacksonville Electric Authority Yes ( ) ( ) Date: Bell South Telephone Company Yes 4,1 No ( ) Date: Ferrell Gas Yes ( ) Date: Comcast Yes No ( ) Date: 2. Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation, alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public Works, any or all of said poles, wires, pipes, cables or other facilities and appurtenances authorized hereunder, shall be immediately removed from said street or easement or reset or relocated hereon as required by the Director of Public Works, and at the expense of the Permittee unless reimbursement is authorized. 3. All work shall meet City of Atlantic Be- • or Florid- sepal -1 of Transportation Standards and be performed under the supervision of , . I. ...... _ ... .::r.:•. ' (Contractor's. Project Superintendent) located at 3L, ,c. r r t fvaC ,_o 44 Telephone#: ..�-�`i- / I 4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee. 5. All city property shall be restored to its original condition as far as practical, in keeping with city specifications and the manner satisfactory to the city. 6. A sketch of plans covering details of this installation, as well as, a copy of a recent survey shall be made a part of this permit. Calculations showing any increase in impervious area on owner's lot or in the city Right of Way are to be included with this application. 7. This permittee shall commence actual construction in good faith withiw Pi days. If the beginning date is more than 60 days from date of permit approval, then permittee must review the permit with the Director of Public Works to make sure no changes have occurred in the area that would affect the permitted construction. 8. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right, title and interest in the land to be entered upon and used by the holder, and the Holder will, at all times, assume all risk of and indemnify, defend, and save harmless the City of Atlantic Beach from and against any and all loss, damage, and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. 9. The Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again immediately upon completion. RECEVEL • CITY OF ATLANTIC BEACH OWNER BO; " ;\;r= R. 7 ' *=, �'1� Date: 6 a I Signed: Before JUN 2 Ca 2007 Before me thi .+; = .;•�- � r�;h� • Suva State Of Florida, has personally a eq J P�bli�- State of Fbrida ! Notary Public at Large,State of Flotid ,. ..of �1.• My commission expires: My Commission Expires Feb 14,2010 -rsonally Known: ommisp+Ag icati : 1 ,,9 ,...."4,,, Bonded By Nationalional Notary �_.�, ,4f3 (1 591 (li — U —8 • may►; -, ET Aim fpl Vuohr e-toc S glib) rS``j` CITY OF ATLANTIC BEACH � CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS _ 904 247-5800 800 Seminole Road!',n,s�oV Atlantic Beach, Florida 32233-5445 Fax 904-247-5845 PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION. Date (:(2) ` . 6 0 • PERMIT# // r ISSUED BY THE CITY Job Address 3 ( : cc:r� 1 ivG C E A-�.A Permitee: iv( rr>>1C(I2 eTc' —S& I j —rj <'Telephone# 321-* OJ/ Permittee Address: C'.� 0r�.A I'Vc,e_�00 ,0 /`-0 74 P Requesting Permission to Construct: ( j(?--e ta_A✓c' t�Pi, U (j/li1/-_y - CO _e Te_- Location: (Reference to Cross-Street) Se /A I n/ee-� I<0 -/- 1. Applicant declares that prior to filing this application he has ascertained the location of all existing utilities, both aerial and underground and the accurate locations are shown on the sketches. A Letter of Notification was mailed to the following Utilities/Municipalities: Jacksonville Electric Authority Yes ( ) ( ) Date: Bell South Telephone Company Yes air No ( ) Date: Ferrell Gas Yes ( )24n ( ) Date: Comcast Yes (.1, No ( ) Date: 2. Whenever necessary for the construction, repair, improvement, maintenance, safe and efficient operation, alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public Works, any or all of said poles, wires, pipes, cables or other facilities and appurtenances authorized hereunder, shall be immediately removed from said street or easement or reset or relocated hereon as required by the Director of Public Works, and at the expense of the Permittee unless reimbursement is authorized. 3. All work shall meet City of Atlantic Be- or Florid- R pa -i of Transportation Standards and be performed under the supervision of ., - •....i A. :.:a.:�% (Contractor's. Project Superintendent) located at � L,(g c Ar■ i /W :..o 6 Telephone#: .. _�ii.-:_S o/ 4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee. 5. All city property shall be restored to its original condition as far as practical, in keeping with city specifications and the manner satisfactory to the city. 6. A sketch of plans covering details of this installation, as well as, a copy of a recent survey shall be made a part of this permit. Calculations showing any increase in impervious area on owner's lot or in the city Right of Way are to be included with this application. 7. This permittee shall commence actual construction in good faith withid.t /1-/ days. If the beginning date is more than 60 days from date of permit approval, then permittee must review the permit with the Director of Public Works to make sure no changes have occurred in the area that would affect the permitted construction. 8. It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right, title and interest in the land to be entered upon and used by the holder, and the Holder will, at all times, assume all risk of and indemnify, defend, and save harmless the City of Atlantic Beach from and against any and all loss, damage, and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges. 9. The Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again immediately upon completion. OWNER Signed: Date: . G O Before me thi -<:..d_. .. ,r .•eto . ouval. State Of Florida, has personally a e ` 'P;ol PuWi� State of Floods Notary Public at Large,State of Flo igr t� ,of Iii&i.. My commission expires: o=•. 'I��ii•_My Commission Expires Feb 14,2010 _rsonally Known: s; PJs omm sppg.' '-'. :-ai icati Bonded By National Notary •ssn. •r i I - MI ci AI V 1 ct-c--K — Lit i S Itaik a- 14 WO C:-14-i, CITY OF ATLANTIC REACH PERMIT it , +fn' BUILDING / ZONING DEPARTMENT APPLICATION # 800 Seminole Road O 1 �(/~ Atlantic Beach,Florida 32233 ' (904)247-5800 Jf;t)r (904)247-5845 Fax www.coab.us APPLICATION TRACKING FORM ��^� REQUIRED DEPT: 34) ,,I ,/n I� �� Y N PLANNING �IN4 1/Y o L Y Cz Property Address: Z ,o /�I P. Y N PUBLIC •" Applicant: -1;14i1-5 (, D?(r -T e 0 Y N PUBLIC UTILITIES Y N FIRE DEPT. Project: Y N PUBLIC SAFETY APPROVAL REQUIRED AGENCY: RECEIVED BY: INITIAL: DATE: w Y N D.E.P HUFSTETLER o z Y S.J.R.W.M.D. CARPER 3�-/0 7 < Y I ARMY CORPS of ENG CARPER Y N HOTELS&RESAURANTS HUFSTETLER APPLICATION STATUS CIRCLE ONE: SITE BUILDING DA AP INITIAL: DATE: ❑ I 1 1 ST REV I ❑ 1 ❑ I PLANNING BUILDING 0 1 ❑ 2ND REV I ❑ I ❑ I /4-<._ /-/11/4 PUBLIC WORK 4►2!4 PUBLIC UTILITIES FIRE DEPT. _ ❑ I ❑ I 3RD REV 101 ❑ I I PUBLIC SAFETY RECEIVED! JUL 3 1 2007 BY: •Return this form to the Building Department once you have entered your comments into the AS400. Rug 03 07 08: 10a C. ROGERS 904-2877584 p. 2 \ 0 1 - zZ)■ '-' 5,o- -2i:::=Ti‘,]: '4 ()\ FTh i , „.1 - 4 i i 1Z k 41 ) \(% ('‘) Cb ' \c-' r \ I . Z c' F u, ,. , , a c .'' ci. -,- fl-,. , ,,, , __ . .. .\ ___._ k, n \---- L__ Z ii- ' ),) (-c) . I \74 1 c 1 1 . — 1 a T ° --- .7 , 106713 MAP SHOWING .BOUNDARY SURVEY OF LOT Z4 Z- BLOCK - AS SHOWN ON MAP OF &7412. 5&G7fOJ Z . AS RECORDED IN PLAT 800K /O PAGES i5 OF THE PUBIJC RECORDS OF DUVAL COUNTY, FLORIDA CER77FIED FOR: /1/74 LY £ . .4n/0625 0 Al ' 'reek/A2.I 77TC.E O/= J 4C.t..50,1✓I LL.E Ink._ . C2A1T2&E e FA[_(.AL , P.4. ./ -nc/c.a7—fo Mc C 1u /TS/ C4& Union/ -3Z r5,0,QP _ is _ G47_J��a 50, /4 D, ■"4 ., ,,' if\-- ....-. ......_ ,. , .0,v c-,)-t 6 ,1---- i U ‘)-')) r '- -1157-- GI/ 7.5 7 5'1' ZQ• 'r Z(o3 d /•S7 Y. h/ 4. ,► % ' nr-Ai r,.."jtk.. szcs ,„.4 . '3 9_, 0. t • - .:.1 D. O'r , N Zi.4' 'r N_ x • w ill v .: 0 i'l •O cj ;• .1 ' jy-2\: : SO • 5f. 00 . . - 7r Co,� n'1/n/p L a (C( ' 2� (50 .270 . THE PROPERTY SHOWN HEREON APPEARS TO LIE WITHIN now HAZARD ZONE___2(__AS SCA, D FROM FLOOD .u............- ....- Alin 1 --- ----- --_ _- w " - ' Impervious surface calculations % formula: Find square footage of- House footprint •_ O'� f 0 Driveway — ") Sidewalk LPL f. A/C pads Detached garages or sl.t:d Pool decking Patios, etc. Add the total square footage of the above then divide the sum by the tota.lot area. -"''`J CITY OF ATLANTIC BEACH PERMIT :: t, , BUILDING / ZONING DEPARTMENT APPLICATION # '� 800 Seminole Road /� �� J 4.: ,i Atlantic Beach,Florida 32233 (/ :l (904)247-5800 �' J (904)247-5845 Fax - www.coab.us RECEIVED JUN: `,., 72007 APPLICATION TRACKING FORM By:_ REQUIRED DEPT: `�/ / Q / Y N PLANNING Property Address: d(�(! ��/22 j/✓Q`� /�-ct z N BUILD] G F- N UBLI A •:• s D Applicant: .t/3 /DI Cri✓ GE Y- N Y N FIRE DEPT. Project: C/ e /f7- '' {L Y N PUBLIC SAFETY (/) APPROVAL w U o REQUIRED AGENCY: RECEIVED BY INITIAL: DATE: Z cr Y N D.E.P HUFSTETLER Q• 3 Y N S.J.R.W.M. CARPER _ cL ( Y I N ARMY CORPS of ENG CARPER ��di/U( H Y N HOTELS&RESAURANTS HUFSTETLER APPLICATION STATUS CIRCLE ONE: SITE BUILDING DA AP REVIEWED BY INITIAL: / DATE: El 0 1ST REV 7(r- %`'_ a -- . / se4. /cc-2 (IP) r7vv l CO 14,7 71A-,), 76, PLANNING - 0 0 2ND REV BUILDING .PUBLIC WORKS PUBLIC UTILITIES FIRE DEPT. PUBLIC SAFETY 0 0 3RD REV Return this form to the Building Department once you have entered your comments into the AS400. r -5n- w9 Public Works Plan Review Comments I Date: 6/074 1 Initials: Project Name/Address: 3/1(e ��ir1 /`5Cr_ Application/Permit#: 07-9/0 e�/'c 4�i Check Box Application Tracking Comments To Add Comment Provide impervious surface calculations. Provide erosion and sediment control plans with installation details and maintenance schedule. Provide drainage plans showing site topography(flow arrows, etc.) ❑ Provide construction site management plan, including Right-of-Way Permit if using right-of-way for construction parking. Provide a pre-construction topographic survey prepared by a Florida Licensed ❑ Professional Land Surveyor, showing 1' contours. Section 24-66(b) of the Land Development Regulations requires on-site storage for increased runoff. Provide Delta volume calculations and on-site retention required per ❑ Section 24-66(b). (See attached info. Sheet) If on-site storage is required, a post construction topographic survey documenting proper ❑ construction will be required. A Right-of-Way Permit must be obtained. A Revocable Encroachment Permit must be obtained for ❑ Pool—Wellpoint (if used) must discharge into vegetated area 10' minimum from street ❑ or drainage feature (swale or structure) All driveway aprons must be concrete, 5 inches thick, 4000 psi, with fibermesh from the edge of the pavement to the property line. Reinforcing rods or mesh are not allowed in the ROW (Commercial driveways—6" thick). Any utility cuts in the road must be repaired using COJ Standard Detail Case X and must be overlaid 10 feet in each direction from the center of the cut. Repair must be shown on ❑ the plans. _ .per- j l03 F:\P lanReviewComments-P W.doc 106713 MAP SHOWING BOUNDARY SURVEY OF LOT Z4 Z. BLOCK — AS SHOWN ON MAP OF 5 4 TQ l 2 5 E-G i i o Al L AS RECORDED IN PLAT BOOK /O PAGES l'S OF THE PUBLIC RECORDS OF DUVAL COUNTY. FLORIDA C E R T I F I E D F O R: �74LY k. . QA/06/Ls0AI . j r -k/13Li T7T e or J4C 5c'A)✓/c.c.s (SIC- ./LA�T/LeE e P4L.(.4f� , P.,a. , Enacii r�onl4c. �oniMr1 ITV Cl,_(AIL.," LE.01- VA//o n./ -3Z (5-0.oo 'p . _ 1Q /A Sg 57-. 1 oc. t z610°7 . — ZQ r Q sQ % ►� f,_ o 1. o= a w Q. . . n Z�l•_ . N • . % N •\91 /O .•0 o 0\n . .0 c5' 5S. 00 ' • '�� 7-0 Co,�•(5-0 27�) THE PROPERTY SHOWN HEREON APPEARS TD LIE WITHIN FLOOD HAZARD ZONE X AS SCALED FROM FLOOD a 1 F 0_,t. '\-1:f/e=1 s l ° CITY OF ATLANTIC BEACH :'`` 800 SEMINOLE ROAD ..J E% J� r V ''.,.. :v ATLANTIC BEACH, FLORIDA 32233 > INSPECTION PHONE LINE 247-5826 Application Number 04-00028656 Date 7/13/04 Property Address 366 SEMINOLE RD Tenant nbr, name 100AMP, 1PH, 3W, 240VOLT Application description . . ELECTRIC ONLY Property Zoning TO BE UPDATED Application valuation . . . 0 Owner Contractor LEEMIS, SCOTT BROOKS & LIMBAUGH ELECTRIC 366 SEMINOLE ROAD 41 2ND STREET WEST ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233 (904) 241-9051 Permit ELECTRICAL PERMIT Additional desc . Permit Fee . . . 70 . 00 Plan Check Fee . . .00 Issue Date . . . Valuation . . . . 0 Fee summary Charged Paid Credited Due Permit Fee Total 70 . 00 70 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 Grand Total 70 . 00 70 . 00 . 00 . 00 • PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODE C s /1172X• BUILDING OFFICIAL ,s-=L"f CH /� " , CITY OF ATLANTIC BEA up)T3.1 �� - ELECTRICAL PERMIT APPLICATION Date: 7-1 3 K Property Address: 1� (o 5 ' ' /Qc2/eto Owner: $r7>77 7 "i`toted ,462-=7''7(__S Telephone #: Contractor: ,4%1 K5 4112 i c- Telephone#:(.22y/-r0C-7 Contractor Address: C-6Z cc, '?'77.- 5i • //-7-1 /36l1' ' Fax#: ;?ylF`v703 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. If other construction is Building: Building Type: ❑ Trailer Service: being done construction on this building ❑ New Residence ❑ Temp. ❑ New Or site,list the building Old ❑ Commercial ❑ Signs ❑ Increase Permit number: ❑ Re-wire ❑ Addition Sq.Ft. ❑ Repair Conductor Size: AMPS: COPPER ❑ ALUMINUM ❑ RACE Switch or VOLT WAY Breaker AMPS PH _W Existing Service RACE Size AMPS /b0 PH W 5 VOLTP< / WAY Feeders: NO. SIZE NO SIZE NO SIZE Lighting Outlets CONCEALED OPEN - Receptacles CONCEALED / • OPEN 0 30 AMPS 31 100 AMPS , Switches Incandescent Fluorescent & M.V. BELL Fixed 0.100 AMPS OVER Appliances TRANSFER. Air H.P.RATING H.P.RATING CEILING KW-HEAT Conditioning COMP.MOTOR OTHER MOTORS AMPS HEAT Motors 0-1 H.P. VOLTAGE PH I NO. OVER 1 H.P. PHS UNDER600V _OVER600V • Transformers NO. KVA NO. KVA No.Neon_Transf. Ea._Sign ;,K,/, �t7' ei Miscellaneous / Lt N43/4)6- G/-1_ ,�ECc� -:JfS G/ c/C C- ,ee--ePm � /< M/ss<. G 800 Seminole Road•Atlantic Beach,Florida 32233-5445 Phone: (904)247-5800• Fax: (904)247-5845 • http://www.ci.atlantic-beach.fl.us PAGE 15 INSPECTION TICKET PAGE 6�18�05 CITY ATLANTIC 1:28:25 INSPECTOR: LARRY 3 HIGGINS CITY OF ATLANTIC BEACH -------- ---------- -----------------" -- (�I --------- ------------ SUBDIV: r �� - {l�o ADDRESS : 366 SEMINOLE RD TENANT, NBR: 10 FIXTURES PHONE �Y1 OWNER : BILL EEMIS, SCOTT al-Act-4+45S IN PHONE : 1 ' / �� OWNER Cr""` L� PARCEL . : 110421-0000- - __ _ _ _________ =- APPL NUMBER: 03-00026254 PLUMBING ONLY _ __ _ _ _______ _ _ --------------------- MIT: PLBG 00 PLBIBIIGNSPUIT DE RIPTION REQUESTED COMPLETED RESULT R%SULTSICOMMENTS -- -------- -- -- TYP�S4 ---- -C) ----- /., • _ J� 01 Cl 18103 LJH _______ COMMENTS AND NOTES --- --- a • • A 0� CITY OF ATLANTIC BEACH \c i -� f sA .,.- J 800 SEMINOLE ROAD '6= i .- ATLANTIC BEACH, FLORIDA 32233 INSPECTION PHONE LINE 247-5826 Application Number 03-00026254 Date 6/09/03 Property Address 366 SEMINOLE RD Tenant nbr, name 10 FIXTURES Application description . . PLUMBING ONLY Property Zoning TO BE UPDATED Application valuation . . . 0 Owner Contractor LEEMIS, SCOTT BILL FENWICK PLUMBING, INC. 366 SEMINOLE ROAD 8245 BEACH BOULEVARD ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32216 Permit PLUMBING PERMIT Additional desc . 10 FIXTURES Permit Fee . . . 105 . 00 Plan Check Fee . . . 00 Issue Date . . . Valuation . . . . 0 Fee summary Charged Paid Credited Due Permit Fee Total 105 . 00 105 . 00 . 00 . 00 Plan Check Total . 00 . 00 . 00 . 00 i,,, Grand Total 105 . 00 105 . 00 . 00 . 00 r 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 PROPERTY RESULT IN THE OWNER IMPROVEMENTS"IP IPROVISIONS APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TO REVOCATION FOVIO VIOLATION F L ' J :_, BUILDING OFFICIAL J ti ab 'v tt 11 ,-,$) iii!kt.',i CITY OF ATLANTIC BEACH V. PLUMBING PERMIT APPLICATION...........) Asst, _ Date: A ( Job Address: �1..2 Lo ems E Owner of Property:'SQ L w ".3 Telephone: k/C2`Q(1(.Q(D Plumbing Contractor: l�--Q Jar ( T I 10(rl. `_J-1, C g S Contractor's Address: U a 4 d Telephone: Q 1a4 - (10-2.L Fax: 7 - 4 --wce State License Number: (. FCCA 0 O3 How many of the following fixtures (re-piped or new): i Sinks Showers Water 2- Lavatory I Water Heaters i Hose Bib 1 Bathtubs Dishwashers Sewer Urinals Disposals Other Closets \ Washing Machine Shower Pans _...y,_ Floor Drains _Re-Pipe (List fixtures being re-piped) Total Fixtures: ( 0 x $7.00 + $35.00 = (Minimum Permit Fee: $35.00) 7. Signature of Contractor: (\ ?. MX ll— Installation of plumbing and fixtures must be in accor ce with the most recent edition of the Southern Standard Plumbing Code. Call a day ahead to schedule inspections: (904) 247-5826 800 Seminole Road •Atlantic Beach,Florida 32233-5445 6613 PSR-3844 . DEPARTMENT OF BUILDING CITY OF ATLANTIC BEACH ----- PERMIT INFORMATION -- LOCATION INFORMATION Permit Number : 6613 Address : 366 SEMINOLE ROAD Permit Type: ELECTRICAL ATLANTIC BEACH, FLORIDA 32233 'lass of Work: ALTERATION LEGAL DESCRIPTION t Type: WOOD FRAME Lot : Block: Section: Cons r . Typ Proposed Use: SINGLE FAMILY Township : RNG: 0 Dwellings : 1 Code: 0 Subdivision : Estimated Value: $0 . 00 Impray . Cost : $0 .00 Total Fees : $25 .00 Amount Paid: $25 . 00 Day "!3 Work 1, _ wry, "- r1I3W23OV SEURW 2 . 5. ON AC CIR{'HITS OWNER INFORMATION - ---- APPLICATION FEES PERMIT $25 .00 Name: LEFMIS Address : 36f, SEMINOLE ROAD WATER IMPACT FEE $0 . 00 ATLANTIC BEACH . FLORIDA 322 _ SEWER IMPACT FEE $0 .00 0 Phone : ( 904 ) 24'?-9061 WATER METER $0 .00 RADON GAS-H.R . S . $0 . 00 CONTRACTOR INFORMATION RADON GAS - 5% $0 .00 TAP $0 .00 Name: MCCLURE ELECTRIC COMPANY WATER TA O . 00 Address : P .O . BOX 51368 SEWER TAP $$0 .00 JAX . BCH . FL . 32240-1368 HYDRAULIC SHARE ran �8 Type: 2 RE-INSPECT FEE $0 .00 L� ^en" EF__ 8] 8 SEC .H IMPACT FEE $0 . 00 ^THER $0 . 00 NOTES: NOTICE -ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE BUILDING MATERIAL, BY DEBRIS FROM THIS WORK RK MUST NOT BE PLACED IN PUBLIC SPACE,AND MUST BE CLEARED UP AND HAULED AWAY "FAILURE TO COMPLY WITH THE MECHANICS' LIEN LAW CAN RESULT IN THE PROPERTY OWNER PAYING TWICE FOR BUILDING IMPROVEMENTS." VALIDATION DATE: 04/12/93 ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECTrDTIQ REVOCAI>h MIEIRPI VIOLATION OF APPLICABLE PROVISIONS OF LAW. TENDERED R2.00 CHANGE $.00 RECEIPT NUMBER: 084931 ATLANTIC BEACH BUILDING DEPARTMENT By: , ,/' TIC BEACH, FLORIDA CITY OF ATLANTIC (27 Approved by APPLICATION FOR ELECTRICAL PERMIT I TO THE CHIEF ELECTRICAL INSPECTOR: DATE: 4' i I 2.- 19 13 IMPORTANT NOTICE: IN CONSIDERATION OF PERMIT GIVEN FOR DOING THE WORK AS DESCRIBED IN THE FOLLOWING, 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 ELECTRICAL REGULATIONS, CODES AND CITY OF ATLANTIC BEACH ORDINANCES. E Z,^O L , v� it , d—,c.o�-pct)t h e ��Ll.�rt� \E -r �c�L ELECTRICAL FIRM: MASTER ELECTRICIAN SIGNAT■ -E JOURNEYMAN NAME ` +.V\\ S ADDRESS:_ 3 G (- 5 WS* POL p E {.AADRFD BOX BLDG.SIZE BETWEEN: RES.1)G APT. ( ) COMM. ( 1 PUBLIC ( ) INDUS. ( ) NEW ( ) OLD ( 1 REW. ( 1 ADDITION ( 1 TRAILER ( 1 TEMP. ( 1 SIGNS ( ) SQ. FT. FEE SERVICE: NEW( 1 INCREASE ( ) REPAIR ( 1 CONDUCTOR SIZE AMPS COPPER ( 1 ALUM. ( 1 SWITCH OR BREAKER AMPS PH W VOLT RACEWAY EXIST.SERV.SIZE `O O AMPS PH 7 W 230 VOLT SC"‘) RACEWAY FEEDERS NO. SIZE NO. SIZE l NO. SIZE LIGHTING OUTLETS CONCEALED OPEN TOTAL CONCEALED OPEN TOTAL RECEPTACLES 31.100 AMPS. 0-30 AMPS. — SWITCHES INCANDESCENT -- - FLUORESCENT &M.V. FIXED ' 0.100 AMPS. 1 OVER APPLIANCES BELL TRANSF. AIR H.P. RATING H.P. RATING CONDITIONING COMP.MOTOR OTHER MOTORS AMPS CEIL HEAT: KW-HEAT I 1 S TO.J 5 KV/ - ' 1 0-1 I OVER MOTORS H.P. VOLTAGE PHS NO. 1 H.P. VOLTAGE PHS / MISCELLANEOUS 1.NSA' A\ M h tw C-\0-t-v k r S f-0 (t. hoc $ sTC-,r . TRANSFORMERS: UNDER 600 V. OVER 600 V. NO. KVA NO. KVA \ , NO.NEON TRANSF. NO. TVA. MA. MOTOR SIZE SWITCH FLASHER EACH SIGN I II FORWARDED $ fl r-- i TOTAL FEES Si PSR3 6606 B.8" DEPARTMENT OF BUILDING CITY OF ATLANTIC BEACH --- PERMIT INFORMATION LOCATION INFORMATION Permit Number : 6605 Address : 366 SEMINOLE ROAD Permit Type: MECHANICAL ATLANTIC BEACH , FLORIDA 32233 .lass of Work: ALTERATION LEGAL DESCRIPTION Constr . Type: WOOD FRAME Lot : Block : Section: Proposed Use: SINGLE FAMILY Township : RNG: 0 Dwellings : 1 Code : 0 Subdivision: ATLANTIC BEACH Estimated Value : $0 .00 Tmprov . Cost : $0 .00 Total Fees : $37 .00 Amount Paid : $37 . 00 rate Paid: 4/ 9/ 93 wr-.rk Desc , : REPLACE EXISTING CENTRAL HEAT AND AIR SYSTEM - - ------ OWNER INFORMATION ----- APPLICATION FEES Name: SCOTT LEEMIS PERMIT $37 .00 Address : 366 SEMINOLE ROAD WATER IMPACT FEE $0 .00 ATLANTIC BEACH , FLORIDA 32233 SEWER IMPACT FEE $0 .00 Phone : ( 904 ) 241-2030 WATER METER $0 .00 RADON GAS-H .R. S . $0 . 00 CONTRACTOR INFORMATION RADON GAS - 5% $0 . 00 Name : COASTAL HEATING AND COOLING- WATER TAP $0 .00 Address : 1117 BEACH BLVD , SEWER TAP $0 .00 JAX BEACH FLORIDA 32250 HYDRAULIC SHARE $0 .00 License: CACO20230 Type: ' RE-INSPECT FEE $0 . 00 SEC .H IMPACT FEE $0 . 00 OTHER $0 . 00 NOTES: NOTICE —ALL CONCRETE FORMS AND FOOTINGS MUST BE INSPECTED BEFORE POURING PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE 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 MECHANR BUILDING IMPROVEMENTS.LIEN LAW CAN RESULT THE PROPERTY OWNER PAYING TWICE FO %ILIUHIItEN MHit: U4/u0'i/J6 ISSUED ACCORDING TO APPROVED PLANS WHICH ARE PART OF THIS PERMIT AND SUBJECT TCI?D FVOCATIBIEF7,� VIOLATION OF APPLICABLE PROVISIONS OF LAW. TENDERED $37.00 t;HNhNbt $.Un RECEIPT NUMBER: 084877 ATLANTIC BEACH BUILDING DEPARTMENT ." f,C e i / J 4 BUILDING AND ZONING INSPECTION DIVISION CITY OF ATLANTIC BEACH � \` ATLANTIC BEACH, FLORIDA 32233 / 6 LJ JJ APPLICATION FOR MECHANICAL PERMIT CAIL•IN NUMBER IMPORTANT — Applicant to complete all items in sections I, II, Ill, and IV. I. LOCATION Street Address: )9 4.6' 5-C-41/...4/0 l C /A • OF Intersecting Streets: Between J(4 /',A Y✓ ° And //.1 Z A BUILDING Sub-division ■ II. IDENTIFICATION — To be completed by all applicants 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 Jacksonville ordinances and standards of good practice listed therein. Name of Mechanical Contractors ! r� Contractor (Print) 00/.4,frA` /7/L'›p rot//y r COOG{,t/ _., Master `gc../.e;C,rJe r /. 7jf )/Z 0/6 Name of Property Owner _f Cpr1' is-f__,14/s- e.i eo 5/S27 i Signature of Owner Signature of or Authorized Agent �� Architect or Engineer 71----- ���Y III. GENERAL INFORMATION A' Type of heating fuel: B. IS OTHER CONSTRUCTION BEING DONE ON 07-EI.ctric THIS BUILDING OR SITE? iL e . L ❑ Gas—❑ Ii ❑ Natural ❑ Central Utility IF YES, GIVE NUMBER OF CONSTRUCTION ❑ Oil PERMIT ❑ Other — Specify /'t,4r /v.-1//'' IV. AMMAN' ECHANICAL EQUIPMENT TO EE INSTALLED NATURE OF WORK (Provide complete list of components on back of this form) Cif' Residential or ❑ Commercial Q-- Heat ❑ Space ❑ Recessed El- Centel 0 Floor ❑ New Building Existing Building "L,1 O'Air Conditioning: ❑ Room ❑ Centel ❑ Duct System: Material .t, Th /it ickness /� Replacement of existing system El New installation(No system previously installed) Maximum capacity / 9 I o 6 0 c.f.m. ❑ Extension or add-on to existing system ❑ Refrigeration ❑ Other — Specify ❑ Cooling tower: Capacity g.p.m. ❑ Fire sprinklers: Number of heads ❑ Elevator ❑ Msnlift ❑ Escalator (number) THIS SPACE FOR OFFICE USE ONLY ❑ Gasoline pumps_ (number) (Received) ❑ Tanks (number) Remarks ❑ LPG containers (number) ❑ Unfired pressure vassal Permit Approved by Date ❑ loiters Permit Fee ❑ Other — Specify LIST ALL EQUIPMENT U AIR CONDITIONING AND REFRIGERATION EQUIPMENT c.Capacity Approving Number Units Description Model Number Manufacturer (Tons) Asenry i do r d,4/ CO.✓)CA/fC' / '', o o . , ' a 4 L- 2. - HEATING - FURNACES, BOILERS, FIREPLACES Capacity Apps (� uV Number Units Description Yodel Number Manufacturer (BTU) Agency //or' t am/' A`E i /(/'/«f I /a !/ O 6 R V O I L-g 5 K.p t) . a / . /J e f TANKS g n i Approvn Hose Many Nominal Capacity Type Liquid Name of SeriaNal v and Dimensions Contained Manufacturer ' DEPARTMENT OF BUILDING PERMIT NO. 5" CITY OF ATLANTIC BEACH,FLORIDA I PERMIT TO BUILD THIS PERMIT MUST BE POSTED ON JOB Date 34> 193 Valuation$ D T T*tiiuT NC —Fee$---------1° This permit not valid until above fee has been paid to City Treasurer,and is subject to revocation for violation of applicable provisions of law. I g R.,i v ' S T' - y rV This is to certify that ,a _t -' aul 1g 3/11/0 has permission to Iiilikl Zone Classification Owned by Block_�S/D Lot iI House No. 366 SENISOLE ROAD According to approved plans which are part of this permit NOTICE—ALL CONCRETE FORMS i AND FOOTINGS MUST BE IN Ii =r SPECTED BEFORE POURING. II m PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE o Building material, rubbish and debris 4�D �♦ from this work must not be placed in public space, andmustebe cleared up and anled away by con- ttract. •r •wrier. �— Official. Building O CONTRACTOR DATE I FOR OFFICE USE ONLY PLUMBING ELECTRICAL SEWER 111111111111111.1.00 jIIIIIII I WATER IIIIIIIIIIIIIIIIIIIIIIINII I 1 CI J-%. L. /\rL.Y;; 10 ^{ PL)C tJc FOR PI Ix INS I . :;IT DATE a/1 II 83 (.;L.T I CN — 3 Y, k 4 PI_U.?) FI13a flTk?ckfr,C Coq sT Q( biwc Coy r — - -- f J'. S i LR PLU ".?,ER ---- ------- CI i r/C-:{J:;TY G'ZAL LICENSE NO. ( log$ — — STATE CERTIFICATE 1�0. C FCA 21 S2 ----- - - cJl LDLR (.R Cry':RACTOR PE CF a,II ID! Ni •• e,CJRI ) pda— CG - _S I ':►'S -S::Df;EPS -LAN.; i�RY - __WATER 1FATERS °;�, I S - - — D1 S ,;ASH RS S - - - DI SPCS C:SAL S -Cl_CS E IS -- , �.s I ..,. 1 1-a., NE _ FLOC ;INS ------TOTAL Fl X 7URE C_►J:IT 1 NSTALLATI CN CF PLC1-:31 NG AND Fl)(TURES MUST BE I N RDA':CE h'1 11-1 THE HOST REC_NT EDI TI ON CF SOUTHERN STANDARD PLU 31 NG CODE. { fj 7 FOR OFFICE USE ONLY r Date / — / 19 6-'5. ' Permit # g 71 O Fee$1Q•0 Q CITY OF ATLANTIC BEACH Valuation $. , 0 0 0 FLORIDA House # 3'6 Se"4;it°lc ifi4• APPLICATION FOR BUILDING PERMIT Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building or other structure described. This application is made in compliance and conformity with the Building Ordinance of the City of Atlantic Beach, Florida, and all provisions of the Laws of the State of Florida, all ordinances of the City of Atlantic Beach and all rules and regulations of the Building Department of the City of Atlantic Beach, shall be complied with, whether herein specified or not. The Contractor or Owner-Builder who has been issued a Building Permit is automatically responsible to ascertain that all sub- contractors engaged by him are duly licensed in the City of Atlantic Beach,Florida. To prevent delay or embarrasment regard- ing intermediate or final inspections it is suggested that a list of sub-contractors be submitted to this office so that licenses can be verified. / �[�, ACM/ / /�,� Date ill.a Vt.- -Z_.E. , 19 6 Owner-_171T1_.M-ACM "S•'tM-' -�1-e 60, Address.S a�MJLt , 4-Telephone No. ...21 31 Architect I �-� Address �f�.� Telephone No. Contractor Builder_-4i/ ,_3& 11r.E.L V ,--131-DiecAddress_/.9.Q Q!�iM[7 Telephone No...0 '-4 O7 NF' N cl{� Fla41 Lot No ,,-_(�-- . 4-• Block No. Sub Division--- --41-R E-c X Zone Street Side Between and Sts. Valuation $.-4._Gt40 For what purpose will building be used..RGT/.O.cAt!G=--.Type of construction-. f/ Dimensions of Buildin ..i_`L _L Dimensions of Lot_-... ) �� Size of Footings..M.b_N. 7 ��- ga4 scE Size of Piers Size of Sills Greatest Sill Span in ft. Type Roof____$,,'-t-L-T 1,4./4!„ How will Building be Heated?_,5/)./K_t "Ai-Z---.4' Will Building be on Solid or Filled Ground?____S0_i_1.111. Size of Ceiling Joists 2.X4' , Distance on Centers 1_et 0.t-- .4. , Greatest Span L_2„, -0 " Size of Floor Joists ,N_Le N 4= ,Distance on Centers , Greatest Span " Size of Rafters V X , Distance on Centers /G L�_-+Gr_,. , Greatest Span / to -t9 " This rectangle is to represent the lot. Locate the building or buildings in the right position. Give distance in feet from all lot-lines and existing buildings. REAR LOT LINE Two copies of plans and specifications shall be submitted with application. •Inspections required. 7 .p`' 1. When steel is in place and ready to pour footing. r •.4p" W � z 2. When steel is in place and ready to pour columns and/or lintel. Z H ►, a io=4� a ' 3. When steel is in place and ready to pour beam. . Foi b; E, 4. When framing is completed. Q a S 4 5. When rough plumbing is completed,and ready to cover up. W 6. When septic tank drain field or sewer is laid but before it is covered. N A "'+ A\co 7. Electrical inspection by City of Jacksonville. s 8. Final inspection. Note: In case of any rejection,re-inspection MUST be called for after lio,..p.. corrections are made. c ' • FRONT OF LOT 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 building regulations of the City of Atlantic Beach. , 1401 Signature of Builder_____.____._..:_-: T--�.-4. .= ---=..- Address_ , / i*S."1--••�f ' Signature of Owner Address ,, :_5-4,z/ z DEPARTMENT OF BUILDING FOR OFFI 'E USE ONLY CITY OF ATLANTIC BEACH, FLORIDA Date 19 Permit 4 Fee $ ' Application for Permit Valuation " .--- for Misc. Alterations Hou.;e *, and Repairs G .P(r149 - DESC RI B n� I o S -'G. � port- a, /2e4/ 0 st r e e-f pa v- Ic pa.ci q et 5 been ,p ro u t ct e cQ (state if to repair, alter, add to or move building, erect awnings or signs, etc. ) ��(,� ___ Blk No. Sub..Div Building on Lot 7o. �_ ` Address 3L 6 S ar v.Gt� c� - Valuation $ 950. 0 C`)_ Owner' s Name Nay wood , Dr,w i r r1 9 -3 c . —.__-- BUILDINGS & OCCUPANCY ' - Building Use - Residential or Business PPS r clew+v�t 1 What Plumbing work to be done? 110 VA e— — Size of Present Bldg. c'co S9. 0 . Size of Extension_ 1 % 0 s q . 5 -f- Lot size scX I 0 0 -V-} , Material of Roof v b bl No. of stories now I after altered , ' Material of Present Building (31-K k Material of Extension Vioceir-a a{qd a±f PLANS MUST BE SUBMITTED ITR,P.w''.r'` SIGNS Size Classification (state whether ground, pof, -call, projecting banner) Material of Construction --- Illuminated? Type of illumination or neon) (State wet't1 -r- lamps Will sign be over public property? SUBMIT DRAWING SHOWING CONSTRUCTION OF SIGN AND MET=OD OF HAL -..L G WRITE ADDITIONAL INFORMATION BELOW ) (For canvas awnings provide dimensioned drawing coal QA IMPORTANT NOTICES 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 a. e a part hereof, and in accordance with the building regulations of the City of Atlantic Beach. Southern��f�tandard Buildin Code , Signature of Builder or Owner die /, (T �` Address � i Phone - 7 j 'No) 1 Sz .',a 1 I z 1 I i ,....) r ' . , Y rr 4 .. , , . , , 0 , , ) , I, , ., , ,,.Y ,,,,,.. i I. 7.1737W135- lI .1 ___ 1 t i _ I 1 ' Y ..y. i,1 v C It / ■ i G r { i j 1 1 _j 1- - -- — — i 1 VVoc q 10 0 y nri ...."_ !! i' I, DEPARTMENT OF BUILDING O&r�acAc• CITY OF ATLANTIC BEACH,FLORIDA PE DPI 'S NO. PERMIT TO BUILD THIS PERMIT MUST BE POSTED ON JOB Date S taxber 26=19 85 No Charge Valuation$ Fee$ This permit not valid until above fee has been paid to City Treasurer,and is subject to revocation for violation of applicable provisions of law.'S � _ • Sam Floyd 1 This is to certify that erects tree has permission to bbl resident' - Hugh Classification Zone Massey I Owned by I, Block_--S/D Lot House No. 366 SETIINOLE ROAD According to approved plans which are part of this permit NOTICE—ALL CONCRETE FORMS t AND FOOTINGS MUST BE IN- SPECTED BEFORE POURING. PERMIT VOID SIX MONTHS AFTER DATE OF ISSUE O 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 con- tra owner.jG' e Building Official. `'' CONTRACTOR FOR OFFICE DATE USE ONLY millimiril PLUMBING ELECTRICAL SEWER WATER 11111111011111111 ; - - � ' 11 - ; 41'4.'-- CITY OF 1 ■, fkielatiC &ad 969frieea. 716 OCEAN BOULEVARD ik P.O.BOX 26 —__ , ATLANTIC BEACH,FLORIDA 32233 TELEPHONE 1904)249-2396 APPLICATION FOR TREE REMOVAL PERMIT � DATE -5 /17 �-�.� "0� 1 • Applicant i NAME 7/5 /11 1L 0V eF -�A S ADDRESS /3‘5. 1 g2// or . t'6'4 ciA ' 3 ac2a1 Owner NAME %77; /(L%'7 ,Q74 S.` e Y / ADDRESS 3‘. , e ', /e g cl, A7, SC/ii Location of tree if different from owner' s address : Reason for Removal : S '77/2 f1) A/ Q )eal Aii C 1 L ex rte , n i li.)i4 h d S ti e r q�ho t S _//Gise 3 ° 6fg 1e 5 Rear Lot Line h^a 11e91/12A-55<'Y indicate "-I a ,..a possition of tree on o 0� lot a a) a) .b 'd ,rA ® •r., Front Lot Line All 1 Budding Off' cial