715 Amberjack Ln 2014 patio CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ADDITION
MUST CAtt BY 4PM FOR NE" BAY!NSPE&FteN- 247 58t4
JOB INFORMATI )N:
Job ID: 14-RADD-178
Job Type: RESIDENTIAL ADDITION OUSE
Description: ADD 24' X 14' COVERED PATIO TO REAR OF H
Estimated Value: $750.00
Issue Date: 10/17/2014
Expiration Date: 4/15/2015
PROPERTY ADDRESS:
Address: 715 AMBERJACK LN
RE Number: 171194-0000
PROPERTY OWNER:
Name: TAYLOR, MEREDITH & KENNETH,
Address: 139 SALTWIND CIR
GENERAL CONTRACTOR INFORMATION:
Name: OWNER
Address:
Phone: - -
PERMIT INFORMATION: UTILITY DEPT.: PUBLIC WORKS:
Approval to place roof over existing concrete patio only.
Roll off container company must be on City approved list and container
cannot be placed on City Right-of-Way. Approved companies currently include 1)
Advanced Disposal and 2) Republic Services.
FEES:
BUILDING PERMIT FEE $55.00
STATE DCA SURCHARGE $2.00
PLAN CHECK FEES $27.50
STATE DBPR SURCHARGE $2.00
Total Payments: $86.50
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BUILDING PERMIT APPLICATION
OCT 09
014]
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233 IE33 y
F ILE COPY Office (904) 247-5826 Fax (904) 247-5845
Job Address: 1 'A-�'q 960-_S�PvC I_A-,j4E Permit Number:
Legal Description 50-400 5 6 - �_!S 2-'7 4F Pv s uA;I-t Parcel# tay- 7 #5 f-
S t"7 6 a Floor Area ot- , Sq.Ft. Sq t
Valuation of Work Propo� rl� heated/cooled n�n�heated/cooled 36
Class of Work(circle one): (N�e3 Addition Alteration Repair Move Demolition pool/spa window/door
Use of e�i�ting/pro osed structure(s) ircle one): Commercial Gesidential
If an existing structure,is a fire sprin=system installed? (Circle one):��o <:�Nl�/A
Florida Product Approval#
For multiple products use product app-r-o-vaFforin
Describe in detail the type of work to be performed: q&0
WCA"&- 0'r- '44y S-e_— y—
Property Owner Information:
Name: AR�AJCTW- Address:
City 4_11A*Vc, 311gile 44- State��/Zip� -3 P
Itz 3 hone !!501( -bo 3
E-Mail or Fax#(Optional) Ac-A7;1ty"1b &_ YA"t)-co.—
Contractor Information: CONTRACTOR EMAEL ADDRESS:
Company Name: Qualifying Agent:
Address: city -State Zip
Office Phone Job Site/Contact Number Fax 4
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
4pplication 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 thisjurisdiction. This permit becomes null
and vqid iywork is not commenced within six(6)months, or if construction or work is suspended or abandonedfor aWeri.'od of six ffi)months at any time after
work is commenced I understand that separate permits must be secured r Electrical-Work,Plumbing,Signs, ells Pools, Furnaces,Boilers,Heaters,
fo
Tanks andAir Conditioners,eta
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.
Ihere certify that I have ead dexaminedthis.a ' ati n and know the same to be true and correct. Allprovisions of laws and ordinances goverm.ng this
,�IwOrk will be comp * d ith whether s ec' ere' or not. The granting of a permit does not presume to give authority to violate or cancel the
provi.st.ons of any otherfe a state, aw,reg atin construction or the pe�formance of construction.
Signature of Owner Signature of Contractor
Print Name Print Name
................................................................................ ............................................. ........................................................................................................................................
Befor e Before me
this of 20 /4 0 20
T P --Naa-ryp lic tateaffudda
Shirley L.Graham
. n FF 086990
Notary Public r3i Id6lig/14/2018
136 - -6 Revised 01.26.10
CITY OF ATLANTIC BEACH
Building Department
800 Seminole Road
Atlantic Beach,Florida 32233
D 7 (904)247-5800
PLAN REVIEW COMMENTS
Permit Application # /"-/ - 17
Property Address: 715 Z-z2 ,
Applicant: �6/7/7'fA 7o- �zlae- - owneK
Project: ;?4/ ' x L-o L)e-r e-cl oc,4�o
This permit application has been:
Approved
Reviewed and ihe f—oll��iiig items-wq.attent*
----------------------
C�) SU 6 M., �'e C/ le!?S A tj IV
L V
SLAom,1') q-Oidqtl� -I- 46' r q4lae'.4 ;,k, � a
SS
—4u—,e x i
Please re-submit your application when these items have been completed.
Reviewed By: Date: /0
21
FILE COPY ' ,
CITY OF ATLANTIC BEACH
OWNER / BUILDER AFFIDAVIf
1. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING" REQUIRES OWNER I 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 WITHINr_QZLE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT I IN I
IT FOR SALE OR LEASE, WHICH IS IN VIOLATION OF THIS EXEMPTION. YXI T
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRU, f(,N MRSE'
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGL k S
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED Y01 2014
i3Ou
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIP/
ORDINANCES.
11. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. 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(l). 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.
-7ts- AAF_)cz,—)A_c Fos .600
A PHONE NUMBER
P NAM
L
1��z 1, lt4,_
iIGNATURE DATE
Before me this day f 2jyl.the county of
St AL,no
Duval, ateof orida,has personally appeared herin by himself/herself a d fifirmsthat
all statements and declarations are true and accurate.
Notary Public at Large,State of County of
11 Pers Ily Known
E3 X Identification-
.400 Notary Public State of Florida
'? N Shirley L Graham
Notary Signatur;e: My Commission FF 086990
RL OF Expires 02/1412018
NEE
FIBLDG/0�er-Builder Affadavit;IRIFVIS :4/16 009
Ordered By:
� [S-11-ANDMARK
T I T L E
904 - 998 - 9733 P-misa.
Rvf�.o'
PROPERTY ADDRESS:715 AMBERJACK LN ATLANTIC BEACH,Florida 32233 ISSURVaEY N UMB ER.FL1 1 OM6-MNM
FIELDWORK DATE:7/i/2oi 1 REVISION DATE(S):(-0 7/112011)
L�T 2
5 FIF 112' LOT 22
BLK 5
FL 1106.2002 NO") 2 L6 LOT 23
BOUNDARYSURVEY 4' Al L-3 d BLrI 5
OFFO.21 N N FIF'/Z1
DUVAL COUNTY ON 1 5' 51 U-E. D'E. NO ID
�51`11ED ON .&OFF
L-I CONC to
N 55*2OU2'W 50.65'(P)80.27'(M) cli LOT 9
(13.R.'Per Flat) BLK 5
L-2
N W3955'E 93.00'(P)
N 04'44'0 1"r 92.55'(M) OFFI. AIC
L-3 Q "Im
5 85.2 '02"E 8O.G5'(P) Mn
LOT 10
5 850209129"E 80X61(M) ELK 5 CM
L-4 a) LOT 8
in l5Lr 5
N 55*20'02"W 29.�4'(P*M) na)
PO 1 5TOPY RE5
2 #715
13.7'
U)n
1.901r
FIRC 5/8'
LB#5488
Fl?1/2' P.C.or
COPY L-1 (B.R) NO ID L-4 LOT 8.
BVI 5
A5PHALT
a c;I
A IE53 E
b K LN. Go, R/w/C11
Fo
C; Ln
LOT 3
LOT a PIP 1/21
BLK 2 NO il)@ N.
LOT I P.0-OF LOT
STep NOTM BLK 2 1.Bm 2
1 hereby certi at thij e 0 rVey of the hereon PENCE OWNff?5H[?NOT DETERMINED.
de5cribed pr has be a er my direction, LOT APPEAR5 TO BE 5ERVICED BY CPY WATER AND 5EMR.
and=1, 0 ellef.It 15 a true 5ET13ACK UNE5 5HOWN ON l"LAT,NOT VERJfIED.
a rid
n., 51.1 that meets the
minimum tCC 15tairatamd!D et by the flonda 3.0 0 15 30
Board Of Frof nal n u as Ac5cribed in
Chapter 5J-17 o S UERN inl5trative.Code. GRAPMC SCALE (In Feet)
KEITH A.5TEPHEN50N I inch = 30' ft.
state.1 Floda F'of�l 5—eyor-d MaPper
boanse No.652 1
Uw ofThis Sumey for Purpo—otherthan IntendetiWithoutMitten Verification,will be at the Users Sole RiskardVahout 1-tabilirytothe Survey-
-1hiq h—hall be c—d wGtwANyRiqhu orsenduto Anyoncotherthanihtne Cenified.
POINTS OF INT9Rr=ST.- 1.WOOO SHED IN I.I.E.&D.E. ZFENCE IN I.I.E.&D.E.
FLOOD INFORMATION:
By performing a search at�.ferna.gov,the property appears to be located in zoneX&C.This Property was found in CITYOFATLANTIC BEACH,community
number 12007S.dated 04/17/89.
CLIENT NUMBER; rDATE-7/1/20II LARA HOFFMAN,REALTOR(g)
BUYER:MEREDITH TAYLOR www.LARAHOFFMAN.REMAX.COM WMW
LARAREALTOR@YAHOO.COM
(904)465-3140 ed
SELLER:JUNIOR S.AND ANNARENE F.WELCH
CERTIFIE TO:MEREDITH TAYLOR;LANDMARK TITLE;FIRST
AMERICAN TITLE INSURANCE COMPANY —'surveystars.com
Land Surveyors,Inc. F.......5-1916-F 866-744-2882
This is page 1 of 2 and is not valid without all pages. Wit 7337 1222o Towne Lake Drijve,Suite 5s-Ft.Myers,FL 31913
REPORT OF SURVEY :F1 11:1�O 2 00=2 This is page 2 of 2 and is not valid without
LEGAL DESCRIPTION:
Lot 9,Block 5,ROYAL PALMS UNIT 1,according to the plat thereof,as recorded in Plat Book 30,Page 60,of the Public Records of DUVAL County,
Florida.
JOB SPECIFIC SURVEYOR NOTES:
The Bearing Reference of N 85 degrees 20 minutes 02 seconds W,is based on the northerly right of way line of AMBERJACK LANE,located within
the ROYAL PALMS UNIT ONE,according to the plat thereof,as recorded in Plat Book 30,Page 60,of the public records of Duval County,FL
C=
GENERAL SURVEYOR NOTES:
1. The Legal Description used to perform this summy was supplied by others. This survey does not determine or imply Ownership.
2. This sumey only shows improwi,ments found above greund.Underground footings,utilities and encroachments are not located on this survey map.
3. If them is a septic trink.or drain field shown an this survey,the location is approximate,and was determined by visual above ground inspection only,and Cannot
be relied on for accuracy-
4. This survey is exclusively for the use of the parties to whom it is certified.
5. Additions or deletions to this survey map and report by other than the signing party or parties is prohibited without written consent of the signitrig party or parties.
6. Dimensions are in feet and decimals thereof.
7. Due to varying construction standards,house dimensions are approtimate.
8. Any FEMA floodzwe data contained on this survey is for informational purposes only.Research to obtain such data was performed at
9. All comers marked as set are at a minimum a'h"chameter,18'iron mbar with a cap stamped LB#7337-
10. If you am reading this sLirvey in an electronic format,the information contained on this document in Only"lid if this document is electronically signed as specified
in Chapter 5.1-17.062(3)of the Florida Administrative Code.The Electronic Signature File related to this document is promineritly displayed on the invoicefor this
survey which is sent under separate co,mr.Manually signed and se,led logs of all untey sign,wm files are kept in the office of the perforniiing sumeyon Ifthis
document is in paper forniat;it is not valid vVithout the signature and original aised seal of a Flo,icla,Licensed Surveyor.
11. Unless otherwise noted,an examination of the abstract of title was NOT performed by the signing surveyor to determine which instruments,if any,are affecting
this property.
12. The symbols reflected in the legend and on this survey may have been enlarged or reduced for clarity.The symbols have been plotted at the center of the field
location,and may not represent the actual shape or size of thefeature.
LEGEND:
5URVEYOR5 LEGEND
- N). 1DrWIrIC.TION Sot. SCREEN
rae`us� et Roe, STY. Sim
ELK. BL= L? FRON rJH! 5�
(c) CA`CUL`n`D uCENSt. B115.Nms 15w END—
C�ry CA--TV.NaZK u�r.- S.C.L. SURVEY CLOSLIKE UNr
CONRETE bLOCK.WALL S.T� __nEu.r
C& CENTER LINE L.F� LIGHT POST
ChAIN�UNRorWFMfENC! CONC CONCRETE M 1,T]EASURED TEL. TDEPHD.e FAC-ES
C.V.G. C0NCRrTEVA1_G_ ....- .-1 T.Olk TOP Or EMK
C/5 CONCRETE SLAB N.R. MON RADIAL
IRON"'i - CONCRETE ND�� N.15. �Cn TO 5CALZ _C"L
C', -- --L. --LiNit wit, TNEW CORNER
pt5�ML-------- COR. CORNER. Oh. OVERHANG wAtm FIL'o,
(D) ri�NAI �ALON"L
r-51O.AL 5uRW,cIK AND.�.FT`K
wCC0 CONCRETE DA. DR;VEWAY PLs PROIT55IONAL LAND SURVEMR
F.. m PLAT
EUB ELECTR.IC-_ED. Ig ,,-=- A.'
=Tal ENCL. ONCLO51Ar. P.O.E. MINT or EvrAn-NiNG C V E. C��AL
r. r. wG-or-T -.C. FONT0100.,t f_
WAIM COVERED ARTA E.0 W_ EDGE OF WATER F.T. FoINTOr`T1NG5`,C, C,V�. LC111
F. FENCE U.r P.C. PONY OF CURVATURE D E. �1�1.1
re.ce rctsT FCC. MINT OF COmFOUNP CuWAWOE rssIT� -El
(1) HELD P.R-C- POINT OF REVERSE Ous I rl�t I—--_-1
'k-�OFN r CAtCULAM POINT . FI.1.5.ED FLOOR P_C.F_ PEWMEN'CONTROL FO., LVI
'm FLORIDA FOVIM 4 LIGHT P.- PERLIARENT RUERENCE mONUuffvT
CENPIRAL ANG11,- L.iv E U�
F/Dn MU.%D DRILL HOLE K. RAXIIUS e,RADLAL
FIRC _...I—NOD.CAP RAO, RADIAL TIC I A�C_Ca-E--,?.I
CONCRETE mONUW.-NT FTrC POU.ID ROW PIPE.CAP RE,5. RESIDENCE Ir. 11. TE-IcIt EAS_�211 I
�T_-N 0 RA, RIGrT OF WAY rU& F��&r,UT:r ly rA�'VE%T
rEVATIO14 'OU IRON
r- -u..INC.Pre 511D 15cT NAIL 4 D--7 0 E. itoo��Dkrlll.
.-HoLt MA FOU CONOZETE�ONUMENT `NRC SET IKONROD 4 CAP L-15,47337 5 w t- 5t!3Z�kK 5VT.
TFEC I.- FOLNE,-L 5ET DRH_i_�,Cu! -1-1
:ENsiC V I.V`
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D. ZZ 5 5 U f. ut:T�rilleW.'r
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OFFER VAUD ONLY FOR.
ELECTRONIC SIGNATURE: PRINTING INSTRUCTIONS:
MEREDITH TAYLOR
in order to'Electronically Sign'all of the PDFs sent 1-While viewing the-y in Adobe Reader,select the
by STARS,you must use a hash Calculator.A free "Print"button under the-File'tab.
online hash Calculator is available at 2.Select a printer with legal sized paper. r-----------
,, ::� 3.Under"Phrit Range,dick select the"All'toggle.
To Electronically Sign any survey PDr: : - - - A�. I
1.Save the PDF onto yourcornputer. 4.Uncerthe"Page Handling"section,select the number
2-Usetheonline tool at of copies that you would like to print. POOL-FENCE IsADDITION I
hup ��-iool/rpdi
5.Under the'Page,Scaling'salction drop down men.,
to browse for the saved PDFonyourcomputer.
3.Select the Hash Method as SHA. 6-Uncheck the"Auto Rotate and Center'checkbok
4.ClickSUbMiL '25% off 'I
7.Check the"Choose Pp.,she by PDF"ch.6,1- (UP T.s5.0)
Your PDF is electronically signed ifall ofthe 8.Click OK to print ANY FUTURE
characters in the SHA-1 code submitted by STARS
marches the code which is produced by the hash TO PRINt IN RIACK.VJHrTF- SURVEYING SERVICES
calculator Ifthey match exactly,your PDF is 1.In the..in print., he...'P,.p.HJ.."_ ON THIS PROPERTY
electronically signed Ifthe Codes do not match 2.Choose'Quality"from the option& Offer-lid only for he buyer-Wed on the
exactly,your PDF is not authentic. 3.Ch-9.frm"Auto Color'or"Fll Coloir"t, le�t o,..1 1h.y�1.Io1cF,nt-11.
exceeC$5W.
"Gray Scale". ------------
Exacta Land Surveyors,Inc. www.surveystars.com
16.7337 P 866-735-1916-F 866-744-2882
T.w.O L.k.Drive,Suit.s.-Ft-My-s.FL 33913
ILE 0
�461
�09/
AFFIUDAVIT FOR ATTACHING A NEW STRUCTURE TO AN EXISTING S 52014
CRY---
E-- -
TO: Building Inspection Department,City of Atlantic Beach, 800 Seminole Road - -
Home Owner:
Name
-I/ -57—
StreetAd4-ess
*K011-
q"L
City State and Zip Code
Contractor:
Permit Number
As the Contractor for the proposed new structure located at the above address,I have persona U-y viewed
with the above named home owner those portions of the existing structure on which portions of the
proposed new structure are to be attached for structural support.I am confident that the drawings and
details included with this permit application depict the existing conditions of the host structure,and the
members of the existing structure 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 bold the City of Atlantic Beach
harmless and release it from any responsibility and I iability 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 Atlantic Beach for such consequences or failures.
*copy of this document will be recorded as an official record with the Building Inspection
* rtme t rmit history s that�and all future buyers/owners of this property may be made
'epa 0
aware of ta s of work werf — -p this structure.
Signed . ....Date P/
Before me this /!Z-V Of
In the County of Duval,State of Florida,has personally appeared
herein by himself/herself and
Affirms a1U1 reneclarZns herein are urate.
-To-ffl���tc a�t Large,State County o
N 01'
Personally Known or Pr4u�cedentification--
ID Type
00 P" Notary Public State of Florid.
F:building/affidavit for attaching a new structure to an existing structure. a, 1% 7/21/09
Shirley L Graham
my commission FF oe6990
Expires 92/14/2018
City of Atlantic Be APPLICATION NUMBER
(To be assigned by the Building Department.)
Building DepartimE
800 Seminole Road
14
Atlantic Beach, Florida 31 33-5445
Phone(904)247-5826 - ix(904)247-5845 Date routed: 10161
City web-site: http://www )ab.us
APPLICATIOt REVIEW AND TRACKING FORM
Property Address C Q . 11.Irtment review required Yes No
nong & 7
Applicant: ht4n r)r"+ rtime view Qreqred Yes
Tree Administrator
ublic
Project:
__0 wc
ublic Utilities
u ic aey
JFire Serviices
Review fee Dept Signature
CONTRACTOR EMAI L A D RESS .K-Sbf_a� I CL (401k
0000
CONTRACTOR CONTAL f # 90q' 04')
APPLICATION STATUS
Reviewing Department First Revie Approved. [:]Denied.
(Circle one.) Comments:
�?Approved. []D�
BUILDING
PLANNING &ZONING Reviewed by-.- Date:
TREE ADMIN. ID?i
Second Rev; j: F_]Approved as revised.. FRID ied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: F_]Approved as revised. FlDenied.
Comments:
Reviewed by: Date:
REVISED 09252014
City of Atlantic Beaci-� APPLICATION NUMBER
Building Department To be assigned by the Building Department.)
800 Seminole Road _ RA
I Lf
Atlantic Beach, Florida 32233-5445 DD
Phone(904)247-5826 - Fax(904)247-5845 routed: 10
City web-site: hftp://www -,3ab.us Date
APPLICATIO1 REVIEW AND TRACKING FORM
--v5pw ' lad (-J/) Jpapalment review required Yes No
Property Address. ocr —
Buildina
Planning &Zonin
9p
Applicant: ht4 r)C,4) \4 la
k Tre_FAMrMMtr�ff or
Project: r�Is
P-01-ic Utilities
Public S-,.-ety
Fire Se -,es
Review fee Dept Signature _, ,
CONTRACTOR EMAIL A'JDRESS Kb_�a'Q I OL 'I qa (4a'k 0-0,Lorn
t
CONTRACTOR CONTAL r 9 (�OL�_ 0r
APPLICATION STATUS
Reviewing Department First Reviev �gApproved. [:]Deniee
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by:4xn�/ Date:
TREE ADMIN. Second Revi� �i: F-JApproved as revised. E]Denie
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES
Third Review: [-]Approved as revised. FIDenied.
Comments:
Reviewed by: Date:
REVISED 09252014
City of Atlantic Beaci'i APPLICATION NUMBER
Building Department To be assigned by the Building Department.)
8 eminole Road 14 F78
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-6845 LL Date routed: 0
City web-site: http://www,-:)ab.us
APPLICATIOt REVIEW AND TRAC ING FORM
cin De nt review required Yes No
Property Address U
(� Buildin.
L Planning KZonin-g-)
Applicant: ao Tree A ministrator
Project:
Public Utilities
Public Safety
Fire Ser �s
Review fee Dept Signature
CONTRACTOR EMAIL A-JDRESS KbtaQ I 0'r- '. 01k
CONTRACTOR CONTAL r 9 (�OL�- O-Z ) A00t
APPLICATION STATUS
Reviewing Department First Reviev E]Approved. [$Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by:A- Date: 0011
TREE ADMIN. [:]Denic
Second Revi, ,6,: PKIPproved as revised.
PUBLIC WORKS Comments: Ac f-
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: FlApproved as revised.. Denieu.
Comments:
Reviewed by:_ Date:
REVISED 09252014