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770 TRITON RD SHED 2014 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD J - r ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 SHED PERMIT JOB INFORMATION: Job ID: 14-SHED-165 Job Type: SHED PERMIT Description: 10 x 12 shed Estimated Value: $2,779.00 Issue Date: 10/14/2014 Expiration Date: 4/12/2015 PROPERTY ADDRESS: Address: 770 TRITON RD RE Number: 171333-0000 PROPERTY OWNER: Name: ROCKWOOD, DAVID A Address: 1790 MAYPORT RD PERMIT INFORMATION: FEES: BUILDING PERMIT FEE $63.90 STATE DCA SURCHARGE $2.00 PLAN CHECK FEES $31.95 STATE DBPR SURCHARGE $2.00 Total Payments: $9985 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. APPLICATI BUILDING PERMIT ON BEACH FILE C CITY OF ATLANTICD M 800 Seminole Road, Atlantic Beach, FL 32233 IJ Office (904) 247-5826 Fax (904) 247-5845 n� Job Address: Permit Nimber: Parcel# By ---- Legal Description t Floor ea o q• t• Sq 'Ft of Work$ 2��q C1•D Proposed Work heated/cooled non-heated/cooled 12-6 Class of Work(circle one): Ne 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): es o N/A Florida Product Approval# For multiple products use product approval orm Describe in detail the type of work to be performed: S G� Property Owner Information: Loc_I<< ic,Cj C Address: Name: y cS State�Z1 3 zZ3 3 Phone 6 E4-94 V - 3 S8 & City (�+lc-�-�;c- �-c4 p E-Mail or Fax#(Optional) 2- Contractor Information: Company Name: Qualifying Agent: Address: City State Zip Office Phone Job Site/Contact Number Fax# State Certification/Registration# Architect Name&Phone# Engineer's Name&Phone# Fee Simple Title Holder Name and Address Bonding Company Name and Address Mortgage Lender Name and Address that work mmenced rior isPualnceionis a permit hereby nd that obtain w111 belt to do the performethe d toork and installations as meet the standards of all laws tror work is suionpegulating construction inothpis�urrisa canon This perm it becomesonull and work void if rework is not tI ommenced within six understand that separate permits must or be seeuconstructred for Electrical Work,Plumbing,Sigended or ns,aWells,Poeriod ols, urnaces,Boilers,tHeaters, Tanks and Air Conditioners,etc. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT TEND O OBTAIN FINANCING, CON IMPROVEMENTS LT WITH UR PAYING TWICE FOR TO YOUR PROPERTY. IF YOU IN YOUR LENDER OR AN ATTORNEY BECOMMEOR RECORDINGMENTYOUR NOTICE OF I reythis know t esame to be tand le10vaws nordtnances governing t1 hpeowork w will be complied with whetheriiedheren or not. The granting of o permit does not presume to give authority toviolate or cancel he provisions of any other federal,state, or local law regulating construction or the performance of construction. Signature of Owner c r`—'�-7 Signature of Contractor Print Name Print Name ! ........ ........ ..C..... ............ .��................. BeforVfle Before me 20 this Day 20 this Day of Notary Public ' Shirley L Graham Notary Public y My Commission FF 086990 Revised 10.24.12 of Expires 02/14/2018 s�I y:1TJ j% �„sew^,•,�a:,�r�,yrss�a;,+�a.�.r«�p wr CITY OF ATLANTIC BEACH 7_7 FILE COPY ER / BUILDER AFFIDAVIT I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. 111. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE .OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE"-TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR' TELEPHONE THE BUILDING DEPARTMENT(247-5826) IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. ADDRESS !� PHONE NUMBER PRINT NAME SIGNATURE j� (� DATE Before me this�day of �/ 20 �n the county of Duval,State of Florida,has personally appeared herin by hi se f/herself and affirms that all statements and declarations are tru d))accurate. Notary P blic at Large,State of ­'County of Personally Known D Produced Identification- Notary Signature: el,oz/Vwzo••,ld><q 0669903:1 uolsslwwo0 FW Olt) wetyeJO�491JIyg F:BLDG/Owner-Builder Aft'adavit;REVIS /16/2009 spoolj)o a3erg ollgnd/uei°N Ht E PY Eye Anchor Kit Instructionsa Do-it-Yourself protection for most outdoor structures or possessions. Includes: 3011 Anchors, Wire Clamps & 60 ft Cable Part #59075 0 1. Install ground anchors as close to the building as possible at all four corners. A. Install anchors using a straight rod to turn (screw) anchor into the ground. B. A starter hole,up to 1/3 of the anchor length can be used to start anchor into the ground. Once the anchor eye is level with the ground, backfill the soil and pack area around the anchor eye. C. Anchor eye should be just above soil level. 2. Cable can be secured to the building using the following methods. A. Attach one end of the cable to an anchor using the wire rope clip. Cable goes thru the anchor eye and is clamped together using the wire clips (2). Place the cable over the roof to the opposite anchor, loop cable thru anchor eye. Cut cable to have enough to attach to the anchor. Pull cable tight, attach 2 wire rope clips, tighten nuts. Repeat for other side. B. Attach cable to the side wall studs.Additional hardware required,bolts, washers nuts and wire rope clips. All available at your local hardware supply. NOTE: These instructions are for suggested attachment to small shed not located in high wind areas. For more detailed anchor requirements, see the wind zone charts for your area.You may need additional anchors, cable,wire clamps or other forms of anchor attachments to the shed to meet local or state requirements. Twelve(12) Month Limited Warranty All tie down anchors,when installed in accordance with the manufacturers recommendations and when used within the suggested capacities are guaranteed for 12 months from date of purchase against defects in material or workmanship. If returned prepaid to the factory.TIE DOWN ENGINEERING will replace without charge the defective part.Labor delays or damage are not covered by this warranty and while this warranty gives you specific legal rights,you may also have other rights with vary from state to state. O Instruction#08091 TIE • • Drive www.tiedown.com (404) 344-0000 • • , Statesman w _ I Tall gable with built-in functionality. p � • 7ft.tall side walls 1 1 • Extra-wide 64in.double doors with decorative strap hinges • Includes complete floor 7ft. - Vents Q Window - Loft • shelves Do-It-Yourself Installed ✓ Size/Category Item= Model# Base Item# Base Add Paint At 10 x Sft. S 437 ?' 183553 $1499 437575 $2299 $340 Statesman x Oft. M -572 183560 $1699 437576 $2599 $425 s s, loft.x 12ft. , :371 191305 -$1799 85205 $2799 $510 - . Shown with 11 1Oft.xl6ft. L_- 223874 191404 299 325264 99 680 ❑ 12ft.x 12ft. L E0832 192654—$2199 91031 $3299 $612 optional CI 12ft.x16ft. L 80972 192708 X$2849 91254 $3799 $816 ro -up door ❑ 12ft.x 21)ft_ L 81391 192753 $3349 92703 $4299 $1020_ ❑ 12ft.x 24ft_ L _ 81392 _ 192807 $3849.92947 $4799 $1224 See full specifications on page 13 A s Gentry Distinctive style with country charm. • 7ft. tall side walls • Extra-wide 64in.double doors with decorative strap hinges • Includes complete floor f�r - Vents - Window , Shutters - Loft Workbench - Shelf Pegboard Do-it-yourself Installed ✓ Si Category Item= '.'odel# Base Item# Base Add Paint ft.x 10ft. M 319 r 2'i0o $1899 83287 $2899 $510 12ft.x 12ft L 83367 S2549 92983 $3499 $612 ——' -' —"-- Some models shown with optional accessories. See s_e_ rs en page 13 See page 13 for more details.All stated sizes are nominal. t t .., _ 2 ; § aco / k mLU 04 / ) § » C) cc 0) g j b ! : 2 ) {! / ' J � ' $ § 6 x x = S 6 ~ U 0 : % �) e U bE 04 0- / \ W \ ® -T �) } w % \ § 7 ? -0 § V% ~ \ �T � k / 44i 2 c / \ D ) Er /ƒ _ 3 ® % 0\2 , z \ 6 \ })) § § / - 0 . 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Includes: 3011 Anchors, Wire Clamps & 60 ft Cable Part #59075 1,V a° � 0 1. Install ground anchors as close to the building as possible at all four corners. A. Install anchors using a straight rod to turn (screw) anchor into the ground. B. A starter hole, up to 1/3 of the anchor length can be used to start anchor into the ground. Once the anchor eye is level with the ground, backfill the soil and pack area around the anchor eye. C. Anchor eye should be just above soil level. 2. Cable can be secured to the building using the following methods. A. Attach one end of the cable to an anchor using the wire rope clip. Cable goes thru the anchor eye and is clamped together using the wire clips (2). Place the cable over the roof to the opposite anchor, loop cable thru anchor eye. Cut cable to have enough to attach to the anchor. Pull cable tight,attach 2 wire rope clips, tighten nuts. Repeat for other side. B. Attach cable to the side wall studs.Additional hardware required,bolts, washers nuts and wire rope clips. All available at your local hardware supply. NOTE: These instructions are for suggested attachment to small shed not located in high wind areas. For more detailed anchor requirements,see the wind zone charts for your area.You may need additional anchors, cable,wire clamps or other forms of anchor attachments to the shed to meet local or state requirements. Twelve(12)Month Limited Warranty All tie down anchors,when installed in accordance with the manufacturers recommendations and when used within the suggested capacities are guaranteed for 12 months from date of purchase against defects in material or workmanship. If returned prepaid to the factory.TIE DOWN ENGINEERING will replace without charge the defective part.Labor delays or damage are not covered by this warranty and while this warranty gives you specific legal rights,you may also have other rights with vary from state to state. ti C; Instruction#08091 Atlanta,TIE DOWN ENGINEERING 255 Villanova Drive SW 349-0401 / o • • • / 344-0000 i / i i • / • / !1 TIE DOWN ENGINEERING, INC. ~ 'Alind Zone 1 Anchor Description 112"x 30"Eye Anchor wl 4"helix W Model Number: 59055 Building Building Length(ft.) O Width [ft.) 5 6 S 10 12 14 16 18 20 22 24 26 1 28 = 32 A 5 2 2 . _ 2 2 2 2 _ 2 2 2_. 2 3 3 —3_. _3 g 2 2 2. --2 2 2 2 _. 2. 2 _3_- 3 2 2 _2 _2 2_ 3_._ 3 3 3 3 _2. _2 2 2 2 2 3 3 3- _ --3 3 _ 102 2 2 ? 2 —?- -2 3 3 3 3 3 -_ - 2 2 2 2 _ 2._- 3 3. 3 3 3 4 L114 - - - _ 2 2 2 3 3 3 3 3 44- - _ __.---- -- -_..z_ 3 _ 3 ._3 __ .3_ 3 4 4 _ �. -- -_ 3 4 4 4 4 wmd Zone_ 2 Anchor Description: 112"x 30"Eye Anchor wl 4"Helix Model Number: 59055 My W Building Building Length(ft.) Width 8 10 12 14 16 18 20 22 24 26 J 28 30 32 N 5 ? 2 3 4 4 5 6 6 — 71 8__ _ 9 _ 9 10_ 11 3 4_ 5 5 6 6 7. 7-- $_ 9 9 10 - 3 3 4 4 5... __5 8_ 6 7 7 .- g A -- 8 -- 3 _3. 4 4 5. 5 6 6 7 _ 7 _ _ 8 8 e 10 3 3 4 __4 5 5 6_ -- 6 7__ _.?_ _ 8 - ' 8 12.. _ ___ _ 3 4J 4. 5 _3 8 6 7 L 8 8 Iwo 14 _. _-_ _ 5 5 6 6 77 a8" 66 -... 9 9 18 - - - - Wind Zone: 3 Anchor Description: 1/2"x 30"Eye Anchor wl 4"HOY �y Model Number 59055 �y W Building Building Length ft ) Width O [tt} 56 8 10 12 14 16 18 20 22 24 1 26 28 30 32 5 2 3 4 4 5 6 7 7 8 9 10 10 11 2 13_ 6 -- _.4 5... 5 6 7 7 _. 8 9 9 - 30 11 12 7 ____ - 3 4 --4 - 5 B 6 7 A _ 3 4 4 4 5 5 6 7 10 7 8 i3 9 14 10 _ .. 3 .4 _5 5 6 6 7 $ 8 _ 9 9 10 - ---- __12 -4. 5 5 6 6 7 8 8 8 9 1U _ . - 5 5 6 7 7 8 8 9 10 10 14 _ _ - - = _ _ 6 fi 7 8 8 9 9 10 11 16 ; S 9 g 10 11 11 1$ Notes: 1) Maximum 102"building height. LLJ AD 2) One anchor shall be placed at each corner of building. =:w r� 3) Any required anchors between corners shall be spaced equidistant 0 r" r. 5�4;; i apart from each other. 4) Number of anchors required per side shall be determined by finding P.WITHERINGTON quantities listed in columns. - 1 Calculation Chart Instructions Example: Note* Wind Zone 11 chart shows 12' x 18' building: ,-'K - - - - - - - - - - f �� - 1 - - - - - - - - 1. Looking in 12' column - Use lowest value In the 12 column for the number of anchors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 o 40 2. Looking in 18' column -find the corresponding width of 12'to ' ' Wind Zone II obtain the number of anchors for the 18' side . . . . . . . . . . . . . . . . . . 5 ; 12' x 18' Shed (if building width exceeds the widths shown in the Building Width , column, use the lowest number of anchors in the corresponding Building Width column) I ' ` *NOTE: Anchors at the corners shall be counted only once in !� the quantity required for each side or face of building. ,) - - - - - - - - - - - - - - - - - - - - 3. Total Anchors needed per 12' x 18' shed in Wind Zone 11. . . . . . . . . . . . .12 $uiiding $uild,rg Leng'h{f'. width - (ft} , 6 9 tb `.2 14 16 t z0 n 24 26 28 30 32 s z a a a 6 6 7 s $ $ 6 2 _3. 3 �o » - - - - 4 8 7 -- - - 3 _ 3 -4 4 5 5 -6 6 7 7 8_ �8.. 9 8 3 3 4 4 5 5 6 6 7 _ 9 3 z a` 4 _ 6 6 7 78 E 12 _-4 4 5 2 6 T 7 7 _ B _. _. $ --- 4 55 6 714 1 6 6 _ 7 7 8 -_8- $ 1 6_ 6 7. 7 .. N e m Basic Wind Zone Map ww nND �•2 ; "s Ad yr ott ? I EA MA} �. :A 16 xl a OH:ns l !. Inv (:T ` co KS 1d0 / XVCA J vA �ti ` UK TN NC cu j' AZ ,... to Mf )AL e�GA - --' TX 1 ! 7�ne n AK 7 X as All Q Zone III HI I NOTE: See Section 32W.305(c)(2)for areas included in each Wind Zone. 111 0" I I • I I Eye Anchor Kit Instructions Do-it-Yourself protection for most outdoor structures or possessions. Includes. 3011 Anchors, Wire Clamps & 60 ft Cable Part #59075 i4U oQ �� 0 oQ � 1. Install ground anchors as close to the building as possible at all four corners. A. Install anchors using a straight rod to turn (screw) anchor into the ground. B. A starter hole, up to 1/3 of the anchor length can be used to start anchor into the ground. Once the anchor eye is level with the ground, backfill the soil and pack area around the anchor eye. C. Anchor eye should be just above soil level. 2. Cable can be secured to the building using the following methods. A. Attach one end of the cable to an anchor using the wire rope clip. Cable goes thru the anchor eye and is clamped together using the wire clips (2). Place the cable over the roof to the opposite anchor, loop cable thru anchor eye. Cut cable to have enough to attach to the anchor. Pull cable tight,attach 2 wire rope clips, tighten nuts. Repeat for other side. B. Attach cable to the side wall studs.Additional hardware required,bolts,washers nuts and wire rope clips. All available at your local hardware supply. NOTE: These instructions are for suggested attachment to small shed not located in high wind areas. For more detailed anchor requirements,see the wind zone charts for your area.You may need additional anchors, cable,wire clamps or other forms of anchor attachments to the shed to meet local or state requirements. Twelve(12) Month Limited Warranty All tie down anchors,when installed in accordance with the manufacturers recommendations and when used within the suggested capacities are guaranteed for 12 months from date of purchase against defects in material or workmanship. If returned prepaid to the factory.TIE DOWN ENGINEERING will replace without charge the defective part.Labor delays or damage are not covered by this warranty and while this warranty r� gives you specific legal rights,you may also have other rights with vary from state to state. p O Instruction#08091 TIE DOWN o va Drive SIM - Atlanta, GA 30336 . www.tiedown.com (404) 344-0000 I349-0401 l / CITY OF ATLANTIC BEACH r 1s)k OWNER / BUILDER AFFIDAVIT I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE. LAW: DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES: STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE. IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE, THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. 111. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES. IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO. 455-228(1). AN"OCCUPATIONAL LICENSE" IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR: TELEPHONE THE BUILDING DEPARTMENT(247-5826)IF IN DOUBT. V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT. -7-70 4C),(- (Nq- 3 S g� ADDRESS !-� PHONE NUMBER PRINT NAME If V. �IIGNATU�REDATE Before me this L day of O 2014 the county of Duval,State of Florida,has personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of FL County of IX.,:nally Known roduced Identification- PungO$tiU at Ftotid� �r► N®tffY ananr Shirit'!y L Gf 086990 mt1 , Notary Signature: My Com14n r p E�PI�s•.2 F:BLDG/Owner-Builder Affidavit.REVI :1) -YI612009 City of Atlantic Bear-,h APPLICATION NUMBER �s S Building Departmet— (To be assig ed by the Building De artment.) 800 Seminole Road ���D _ 7& Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 City web-site: http://www.coab.us Date routed: APPLICATION REVIEW AND TRAC 'ING FORM Property Address: -770 Depar int review required Yes No p Y uildin Applicant: O /�-� nin &Zonin rnistrator Project: X �Jn �.J Public W ks Public Utilities Public Safety Fire Services Review fee $ Dept Signature CONTRACTOR EMAIL ADDRESS CONTRACTOR CONTACT # APPLICATION STATUS Reviewing Department First Review Approved. ❑Derned. (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by:�-+s.. � /`�— Date: °/►/!y 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. ❑Denie. Comments: Reviewed by: Date: REVISED 09252014 APPLICATION NUMBER (To be assig ed by the Building D/ (a m Building Departme City of Atlantic Beath //(/!, J3 � ���D0,5 ,•, 800 Seminole Road r� Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM ✓ / ) n Department review required Yes No Property Address: �7O ✓ , uildin p ning &Zonin Administrator Applicant: ge� X /� Project: 000, ,' J Public Works D Public Utilities Public Safety Fire Services Review fee$_- Dept Signature CONTRACTOR EMAIL ADDRESS CONTRACTOR CONTACT # APPLICATION STATUS Reviewing Department First Review: Approved. ❑Denied. (Circle one.) Comments: 906- UILDI Date: O ��--/ e PLANNING &ZONING Reviewed by: TREE ADMIN. 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