1600 Selva Marina Drive 13-00100094 (Drainage Sewer Engineering) CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00100094 Date 2/10/14
Property Address . . . . . . 1600 SELVA MARINA DR
Application type description DEV REV COMM AND INDUSTRIAL
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
----------------------------------------------------------------------------
Application desc
ENGINEERING PLANS/DRAINAGE/SEWER ROAD
----------------------------------------------------------------------------
Owner Contractor
------------------------
------------------------
SELVA MARINA COUNTRY CLUB BARCO-DUVAL ENGINEERING INC
1600 SELVA MARINA DR 1462 HEATHER GLEN LN
ATLANTIC BEACH FL 322335616 MIDDLEBURG FL 32068
----------------------------------------------------------------------------
Permit . . . . . . DEV REV COMMERCIAL/INDUSTRIAL
Additional desc . . . 00
Permit Fee . . . . . 00 Plan Check Fee 0
Issue Date . . . . 12/10/13 Valuation . . . .
Expiration Date . . 12/10/13 ---------------
-------------------------------------------------------------
Special Notes and Comments
Avoid damage to underground water/sewer utilities . Verify
vertical and horizontal location of utilities . Hand dig if
necessary. If field coordination is needed, call 247-5834 .
Ensure all meter boxes, sewer cleanouts and valve covers
are set to grade and visible.
A sewer cleanout must be installed at the property line .
Cleanout must be covered with an RT1 concrete box with
metal lid. Cleanout to be set to grade and visible .
Fire lines must be metered with a Sensus touch-read meter.
Meters larger than 211 must be installed in a vault as noted
in JEA specifications .
Avoid damage to underground water/sewer utilities . Verify
vertical and horizontal location of utilities . Hand dig if
necessary. If field coordination is needed, call 247-5834 .
Ensure all meter boxes, sewer cleanouts and valve covers
are set to grade and visible.
A sewer cleanout must be installed at the property line .
Cleanout must be covered with an RT1 concrete box with
metal lid. Cleanout to be set to grade and visible .
Fire lines must be metered with a Sensus touch-read meter.
Meters larger than 211 must be installed in a vault as noted
in JEA specifications . ---------------
------------------------------------------------------------
PERMIT Qt41VeMVF*40NLY IN ACCORDANCE WITH NLL-ciTJWARViVAgWE)Wgkli���/AW4HE FLORIDN 0 1
BUILDING CODES.
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Page 2
Application Number . . . . . 13-00100094 Date 2/10/14
----------------------------------------------------------------------------
Other Fees . . . . . . . . . ENG REV COMMERCIAL BLDG . 01
ENG REV PRE APP CONSTR PN 1692 . 22
UTIL REV COMMERCIAL BLDG . 01
UTIL REV PRE APP CONSTR 400 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total . 00 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 2092 . 2S 2092 . 25 . 00 . 00
Grand Total 2092 . 2S 2092 . 2S . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
APPLICATION NUMBER
City of Atlantic Beach
Building Department (To be assigned by the Building Depart ent.)
800 Seminole Road
9 X Atlantic Beach, Florida 32233-5445 1.3 - 1�e
Phone (904)247-5826 - Fax(904) 247-5845
E-mail: building-dept@coab.us Date routed:
Cityweb-site: http://wvfw.coab.us
APPLICATION REVIEW AND TRACKING FORM
-7 / r DepartMent review required Yes No
Property Address: Ak� J461A
Applicant: V/e 4 4[g_nnn &49"-3
Tr inii trator
Project: J72i Public Works�)
_.�-15ublic Utilitieo
12-7-10 Public Safety
Fire Sqrvices
,41 Ao"rw-'r—
Review fee $ Dept Signatur
Review or Receipt
eVi
0- dth7er Agency Review or Permit Required] of Permit Verified By Date
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St. Johns River Water Management District
Armykorps of Engineers
Oivisibn of Hotels and Restaurants
Divis�on of Alcoholic Beverages and Tobacco
Oth4r:
APPLICATION STATUS
Reviewing Department First Review: [�[Approved. [:]Denied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by: Date:
TREE ADMIN. Second Review: F]Approved as revised. E]Denied.
PUBLIC WORKS Comments: 09 1 '),�
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ElApproved as revised. DIDenied.
Comments:
Reviewed by: Date:
Revised 05/14/09
APPLICATION NUMBER
A �LNBER
p
City of Atlantic Beach PP"C T' M
y
(To be assigned by the B�uilding Department.)
4
Building Department 41 ,
;01 800 Seminole Road /3 lee 4� 7
0 -5445
Atlantic Beach, Florida 32233
Phone(904)247-5826 - Fax(904)247-5845 [Date routie
E-mail: building-dept@coab.us
City web-site'. http://Www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Departtpent review required Yes No
Property Address BU�adif�_
PI;qnning &Zorling
Applicant: Tr' iniii trator
�ee_AdLn is
§�blicWorks
Project:
A ublic Uti�lities
Public Safety
rRre Services
Review fee $ Dept Signature r t"'rt a
— Review or Receipt Date SovEf_
Other Agency Review or Permit Required of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation Ll
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: DApproved. DDenied.
(Circle one.) Comments:
BUILDING
PLANNING & ZONING Reviewed by: Date:
TREE ADMIN. Second Review: FlApproved as revised. [—]Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: FlApproved as revised. FIDenied.
Comments:
Reviewed by: Date:
Revised 05/14109
11 ) (5
Tavlor 11 W1
V\,
OkVConsulting and Design Engin",
V
9556 Historic Kings Road S.,Suite 102-Jackson WS 10 V,
Tel:(904)346-0671 - Fax:(904)34
www.taylorandwhite.com
Transmittal
NOW
Please Deliver to: Date: 11/13/2013 Project No.: 12210
City of Atlantic Beach
Bumidina Department Attention: Mr. Michael Griffin
800 Seminole Road
Atlantic Beach 233 Re: Atlantic Beach Country Club
(904)247-5814 Building Permit
These documents are transmitted via: Express
Copies Description
Complete Plans Checklist
Building Permit Application
Remarks:
Mr.Griffin,
Attached is the Building Permit Application and Checklist for the Civil Plan Approval of Atlantic Beach Country Club. This permit will be for
the Civil Horizontal Permit only and does not include any of the vertical structures. Per Mr. Rick Carper,the recently submitted plans to the
City of Atlantic Beach are acceptable for use with this Building Permit Application. Please review and let me know if you need any ZI
additional information. ------I
Thanks,
Signed:
Alex R.Acree, P.E.
Copies To: Fx1 File LJ
Ll L]
This transmission may contain information that is privileged or confidential. It is intended for the sole use of the individual or entity to whom it is addressed If you have received this transmission in error,please
notify us immediately by telephone and return the original message to us at the address below If you are not the intended recipient of this message,or the employee or agent responsibte for delivering the
message to the intended recipient,you are hereby notified that any dissemination,distribution or copying of this transmission is strictly prohibited
Signature of OwnerW2,, I,v,W
Signature of Contractor
Print Name A�k �4'-d
.............................. .................... M 4rint Name 4.......')�t t
..............
Sworn to and subscribed before me Swom to and subscribed before me
thisj3Dayof AIOV4430444.1- 20J-R this 1A Day of 72oe� ��,20/3
Notary P
Y4 N#�PAic
TAMW BNLEY LEVAS
a r*IdI
016
I t f ]
20.2
1188
Ndwy Pubk-Side of Rarlds jAyNft.*MNNAHAIN
MY COMM.ENOU Oct 20,2016 Notary Public,State of Florida
Co"ssion#EE 211887 My Comm,Expires Mar 25,2016
Commission No.EE 1ON70
BUILDING PERMIT APPLICATION NOV 13 2 13
CITY OF ATLANTIC BEACH � y
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845
Job Address: 1600 SELVA MARINA DRIVE Permit Number:
Legal Description See Attached Parcel# 169399-0000.169399-0010,172024-0000
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work SAM Proposed Work heated/cooled non-heated/cooled
Class of Work(circle one): (2) Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed?(Circle one); Yes 0 N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: The re-develovinent of the existing Selva Marina Golf Course
and Country Club with the addition of uo to two hundred(200)single-family lots with associated utilities and
storrnwater manap-ement system.
Pronerty(N,ncr Information:
Name:Atlantic Beach Partners,LLC Address: 414 Old Hard Road,Suite 502
City ileming Island State FL Zip 32003 Phone (904)264-6553
E-Mail or Fax#(Optional) rwoodgwooddev.net
Contractor Information:
Company Name: Barco-Duval Engineering,Inc. Qualifying Agent: Ron Price
Address: 7587 Wilson Blvd. —City—Jacksonville State FL Zip 32210
Office Phone (904)772-1313 Job Site/Contact Number Fax# (904)771-7912
State Certification/Registration
Architect Name&Phone# Cronk Duch Architecture-Cliff Duch,ICAA.A.I.A.(904)302-9848
Engineer's Name&Phone# Taylor&White,Inc.-Alex Acree,P.E.(904)346-0671
Fee Simple Tide Holder Name and Address A-Ha1tcBm6AhAnwLL6 Id 14 rzi,6 RAf 5_6Z Flem;lij r5/44,r-1.
Bonding Company Name and Address -3 714X�.
Mortgage Lender Name and Address Ckoi4a( '601ofions IV,44�� CH(i 5 aak ek-W V *460.-
,r
,t k.Se,_1 L) 6,Q, -:322A
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
T tor to the issuance of a permit and that all work will he pey6r,"ed to meet the slandoribs of all laws regulating construction in thisjurisdiction.
his permit becomes null and void if work is not commence within six months,or if construction or work is suspended or abandonedfor a
b�qf six (6) months at any time after work is commenced I un emand that separate permits must be secured for Electrical War*,
181 ing,Signs,Wells,Pools,Furnace-v,Bolters,Healers,Tanks and Ah,Condftioners,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/have read and examined this application and know the some to be true and correct. All provisions of laws and ordinances
governing this type of work will be complied with whether specified hervin or not. The granting ofa Permit does nolfresume to give aulhorilv 10
t z -
vtolateorcance The provisions ofany otherfederal,slate,or local law regulating construction or thi performance a construction.
Signature of Owner
Signature of Contractor
Print Name �.. O��Print Name
. ...........
Sworn to and subscribed before me Swom to and subscribed before me
thisJ3 Day of Alt] k-0/- 20J-R this /,9 Day of 22W,11ot,ZV
L_12 0 3
IV
N ryP— ic N��P061ic
TAMMY DAILEY LEVAS
f da
: 2016
12
Oc
NMry Public-'Stdo of FWda jAvNv4*MRMA?4
My Comm.Expirn Oct 20,2016 Notary Public,State of Florida
Comngnion#0 EE 211887 My Comm.Expires Mar.25,2016
Commission No.EE 163470
Taylor V1 White, Inc.
Consulting and Design Englnqm
9556 Historic Kings Road S.,SLdte 102-Jacksonville,Floncla 32257
Tel:(904)346-0671 - Fax:(904)346-3051
www.taylorandwhfte.com
Transmittal
Please Deliver to: Date: 11/13/2013 Project No.: 12210
City of Atlant"c Beilch
Building Department Attention: Mr. Michael Griffin
1100 Seminole Road
Atlantic Beach, FL 32233 Re: Atlantic Beach Country Club
(904)247-5814 Building Perrnit
These documents are transmitted via: Express
M-R
W
Complete Plans Checklist
Building Permit Application
Remarks:
Mr.Griffin,
Attached is the Building Permit Application and Checklist for the Civil Plan Approval of Atlantic Beach Country Club. This permit will be for
the Civil Horizontal Permit only and does not include any of the vertical structures. Per Mr.Rick Carper,the recently submitted plans to the
City of Atlantic Beach are acceptable for use with this Building Permit Application. Please review and let me know if you need any
additional information. ------
Thanks,
Signed:
Alex R.Acree, P.E.
Copies To: N1 File U
El Li
This transmission may contain information that is privileged or confidential. It�sitrrtended for the solo use of the individual of entity to whom it is addressed. If you have received this transmission In error,please
notify us immediately by telephone and return the original message to us at the address below- If you are not the intended recipient of this message,or the employee or agent responsible for delivering the
message to the intended recipient you are hereby notified that any dissemination,distribution or copying of this transmission is strictly prohibited.
'Taylor & White. Inc.
6 Consulting and Design Engineers
k6f
9556 Historic Kings Road S.,Suite 102-Jacksonville,Florida 32257
Tel:(904)346-0671 - Fax:(904)346-3051
www.taylorandwhite.com
Transmittal
Please Deliver to: Date: 11/19/2013 Project No.: 12210
City of Atlantic Beach
Bumicinna Department Attention: Mr. Michael Griffin
800 Semilnolle Road
Atlantic Beach, FL 3 233 Re: Atlantic Beach Country Club
(904)247-5814 Building Permit
These documents are transmitted via: Delivery
5 Final Engineering Plans
Remarks:
Mr. Griffin,
Attached are 5 signed and sealed sets of the final engineering plans for Atlantic Beach Country Club. These plans reflect the recent
comments from the City of Atlantic Beach Utilities. Per Donna, only 3 sets are needed for the City of Atlantic Beach however,we are
including 5 sets as we will need at least 2 sets back that are stamped approved by the City of Atlantic Beach. Please let me know if you
need any additional information.
Thanks,
Signed:
Alex R.Acree, P.E.
Received by:
please prunt name signature
Date: Time: Delivered by:
Taylor Vi White, Inc.
Consulting and Design Engineers
9556 Historic Kings Road S.,Suite 102-Jacksonville,Florida 32257
Tel:(904)346-0671 - Fax:(904)346-3051
www.taylorandwhite.com
Transmittal -
Please Deliver to: Date: 11119/2013 Project No.: 12210
City of Atlantic Beach
Buildwina Department Attention: Mr. Michael Griffin
800 Seminole Road
Atlantic Beach, FL 3 233 Re: Atlantic Beach Country Club
(904)247-5814 Building Permit
These documents are transmitted via: Delivery
5 Final Engineering Plans
Remarks:
Mr. Griffin,
Attached are 5 signed and sealed sets of the final engineering plans for Atlantic Beach Country Club. These plans reflect the recent
comments from the City of Atlantic Beach Utilities. Per Donna, only 3 sets are needed for the City of Atlantic Beach however,we are
including 5 sets as we will need at least 2 sets back that are stamped approved by the City of Atlantic Beach. Please let me know if you
need any additional information.
Thanks,
Signed:
Alex k Acree, REV
Copies To: IXI File LJ
U L)
Tlh�s transmission may contain information that is privileged or confidential It is intended for the sole use of the individual or entity to whom it is addressed If you have received this transmission in error,please
notify us immediately by telephone and return the original message to us at the address below. If you are not the intended recipient of this message,or the employee or agent responsible for delivering the
message to the intended recipient,you are hereby notified that any dissemination,distribution or copying of this transmission is strictly prohibited.
PUBLIC UTILITIES PLAN REVIEW COMMENTS
D a t e: IJ12—/L1_3 Initials:(
Project Name/Address: Application Permit#:
Check Box Check
Application Tracking Comments to Add Box to
Comment "Print"
UWSU Avoid damage to underground water/sewer utilities. Verify vertical and horizontal
location of utilities. Hand dig if necessary. If field coordination is needed, call 247-5834.
MBSC Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible.
RT1C A sewer cleanout must be installed at the property line. Cleanout must be covered with
an RT1 concrete box with metal lid. Cleanout to be set to grade and visible.
RPZB A reduced pressure zone backflow preventer must be installed if irrigation will be
provided or if there is a private well on the property. Backflow preventer must be tested 0 0
by a certified tester and a copy of the results sent to Public Utilities.
STIRM Plans note the building will be unsprinkled. If plans change, any fire line installed must
be metered with a Sensus touch-read meter in a properly sized vault and an appropriate 0 0
backflow preventer installed. Backflow preventer must be tested by a certified tester
and a copy of the results sent to Public Utilities.
FSBR If fire sprinkler system is provided,contact Malcolm Clemons at 247-5839 for backflow 0 0
requirements. At a minimum, will require a double check backflow preventer.
FLM Fire lines must be metered with a Sensus touch-read meter. Meters larger than 2" must
be installed in a vault as noted in JEA specifications.
0,a_chee_.k q1 - co6�,.je Seyw-le-e at-&
IrV Ck it
21 E] 0
Co IyVk-je Tidl- J'alrt,-7S 0A-Vj"b-tCA-1.e*- 740Ze .Vlcbm;�6/ vc
0��IroeW keli-ne e"'m
0 0
0 11
0 0
0 0
0 0
0 0
Taylor Vi White, Inc.
(1Z&I Consulting and Design Engineers
9556 Historic Kings Road S.,Suite 102-Jacksonville,Florida 32257
Tel:(904)346-0671 - Fax:(904)346-3051
www.taylorandwhite.com
.. ...........
ransmittal
Please Deliver to: Date: 11/19/2013 Project No.: 12210
City of Atlant"c Beach
Building Department Attention: Mr. Michael Griffin
800 Seminole Road
Atlantic Beach. FL 32233 Re: Atlantic Beach Country Club
(904)247-5814 Building Permit
These documents are transmitted via: Delivery
5 Final Engineering Plans
Remarks:
Mr.Griffin,
Attached are 5 signed and sealed sets of the final engineering plans for Atlantic Beach Country Club. These plans reflect the recent
comments from the City of Atlantic Beach Utilities. Per Donna,only 3 sets are needed for the City of Atlantic Beach however,we are
including 5 sets as we will need at least 2 sets back that are stamped approved by the City of Atlantic Beach. Please let me know if you
need any additional information.
Thanks,
Signed:
Alex R.Acree, P.E�/
Copies To: El File Li
L3 Ll
This transmission may contain information that is privileged or confidential It is intended for the sole use of the individual or entity to whom it is addressed. If you have received this transmission in error,please
notify us immediately by telephone and return the original message to us at the address below If you are not the intended recipient of this message,or the employee or agent responsible for delivering the
message to the intended recipient,you are hereby notified that any dissemination,distribution or copying of this transmission is strictly prohibited
APPLICATION NUMBER
(ro be assigned by the Building DeparbTnt.)
lea 4 ly
...0-
7-5845 Date routed: �/e
Z-W AND TRACKING FORM
P-in jc br _Departtpent review required Yes No
04! q §0��
( Running&go"'
I-NiAdnjinistrator
_j9u lic utillitie
Q
'167- 2-7-/,0 Public Safety
Fire Services
-111111iimm ANN".
NO- �49 1,
Other Agency Review or Permit Required Review or Receipt Date
tection of Permit Verified By
it District
id Tobacco
lea PPLICATION STATUS
pproved.
nDenied.
FL-)r!�;,00Q 12- 2�1.
1:eas 0/7 "am flt�-t-
Revkr4ved by: Date:
L)c.k- pproved as revised. ODenied.
CA Reviewed by: Date:
1�)proved as revised. F]Denied.
IV,
DK, Reviewed by: 00 Dl":
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road,Atlantic Beach,FL 32233
Office(904)247-5826 Fax(904)247-5845
Job Address: 1600 SELVA MARINA DRIVE_Permit Number:
Legal Description See Attached Parcel# 169399-0000 169399 172024-0000
Floor Area of Sq.Ft. Sq.Ft
Valuation of Work$ 6M Proposed Work heated/cooled_ non-heated/cooled
Class of Work(circle one): (D Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circle one): Commercial Residential
If an existing structure,is a firc sprinkler system installed?(Circle one): Yes 0 N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: The re-develor)ment of the existing Selva Marina Golf Course
and Country -'tub with the addition of up to two hundred(200)sinizl -family lots with associated utilities and
stormwater management system.
Proi)erty Owner Information:
Name:Atlantic Beach Partners.LLC —Address: 414 Old Hard Road.Suite 502
City Fleming Island —State-EL Zip 32003_Phone (904)264-6553
E-Mail or Fax#(Optional) rwoodawooddey.net
Contractor Information:
Company Name:_Barco-Duval Engineering.Inc. Qualifying Agent: Ron Price
Address:-7587 Wilson Blvd.
Office Phone (904)772-1313 —City Jackso ville State FL Zip 32210
Job Site/Contact Number Fax# (904)7 71-7912
State Certification/Registration# '
Architect Name&Phone# Cro CU-it5&W 10 dQ4-1517?3 7
- nk Duch Architecture–Cliff Duch,ICAA,A.I.A.(904)302-9848
Engineer's Name&Phone# T I &Whi
UYIQL&N�lnc.–Alex A
Fee Simple Title Holder Name and Address 8E 10 Id 14 4 td Rd. SO 2 Flerw nj fs/c,
Bonding Company Name and Address
Mortgage Lender Name and Address ea u1non-S IV CICI q 6
.LL-C
Appl'c hereb ade h am ape d he w�
a on rm'"o 0' r
h in to 0 and ha a" ork will be
a rm"
e 1 0,
f d�d f_ k co me.e
y
r,or to, e issuance 0
h, becoin,-1 n Or sw`o,
0 ,a 'mi
; sLs f
od (6 lh e a e �rk�comme
ju r s
mbing,S,gns a,P I rna'es,
el F Bin, , ei"r',
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 certt&that I have read and examined this qpplication and know the same to be true and correct. All provisions of laws and ordinances
=ing this ope ofwork will be complied with whether specified herein or not. The granting ofaperinit dois no,,
or cancel the provisions ofany otherfederal,state,or 16cal law regula ,presume to give authority to
forinance a construction.
ting construction or thi per
��:ij>��, City of Atlantic Beach APPLICATION NIJMBER
Building Department (To be assigned by the Builcing Departm ent.)
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone (904)247-5826 - Fax (904)247-5845
-u1n9" E-mail: building-dept@coab.us L Date routed: Ll b 9//.
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 1�a JMIA _1_�)qrin A, Department review required Yes
ple!nniL
Applicant: IVA g &Zorling
Tree-AdMinistrator
Project: C—P ublic Works
_�-Tu— lic Util
t itie5
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
Florida Dept. of Environmental Protection of Permit Verified By
Florida Dept. of Transportation IL rL f.rz,%rd a.4
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: E�Approvecl. E]Denied.
(Circle one.) Comments:
- )
L P5 -:?ZA-)I r r-4-v pt-r 1) - -
BUILDING 4T�i X Xe-V c-0— /�P' 9
P1 Reviewed by: Date:
pproved as revised. OlDenied.
Reviewed by: Date:
pw ]Approved as revised. E]Denied.
t /_7 >
�O
Reviewed by: Date:
ILL
Revised 05114/09