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234 OCEAN BLVD - DRIVEWAY s ?T�`L'y f76 ,� Y�+r`1, CITY OF ATLANTIC BEACH A j 800 SEMINOLE ROAD j ;: ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 J.1119� DRIVEWAY PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 15-DWAY-1133 Job Type: DRIVEWAY Description: patio driveway-pavers Estimated Value: Issue Date: 8/12/2015 Expiration Date: 2/8/2016 PROPERTY ADDRESS: Address: 234 OCEAN BLVD RE Number: LOC ID-0000 PERMIT INFORMATION: PUBLIC WORKS: UTILITY DEPT.: Full erosion control measures must be installed and approved prior to beginning any earth disturbing activities. Contact Public Works (247-5834) for Erosion and Sediment Control Inspection prior to start of construction. All silt must remain on-site during construction. If on-site storage is required, a post construction topographic survey documenting proper construction will be required. Roll off Container Company must be on City approved list and container cannot be placed on City Right-of-Way. (Approved: Advanced Disposal, Realco, Republic Services, Shappel's and Waste Pro.) Full right-of-way restoration, including sod, is required. 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 P.I \1 I 1. APPROVED ONIA IN ACCORDANCE WITH A d. (Try oF ATLANTIC BEACH O KILN\ N 'ES AND 711E FLORIDA h3 ml Tcic erete box with metal lid. Cleanout to be set to grade and visit e. r 1. r,1`r °�' CITY OF ATLANTIC BEACH �ts, -w. 800 SEMINOLE ROAD -)11/,, ____"-y ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 AJJSI)f' • FEES: Fence/ROW $35.00 Total Payments: $35.00 • PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. Permit Attachment of for Permit# issued ,20_Atlantic Beach,FL 32233 Owner's Name: Property Address: R.E.#: Subdivision: Lot#/Block#: REVOCABLE ENCROACHMENT PERMIT THIS REVOCABLE ENCROACHMENT PERMIT,issued on this by Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the State of Florida, hereinafter referred to as "CITY" and hereinafter referred to as"USER". of Atlantic Beach; Florida, WITNESSETH: That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon the property of the City of Atlantic Beach for the Beach Right-of-Way/Easement permit numbers noted above(copies pose ttached) cnbed in the City of Atlantic This work is generally described as: A la - Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege subject to relocation or removal on p g granted remains thirty(30)days notice by CITY to the USER, said notice to USER shall be given by certified mail, reMm receipt requested, to the following address: The depositing of said notice of cancellation in the United States mail shall constitute the notice of cancellation and the burden is upon USER to keep the CITY informed of USER's proper address. The USER shall promptly make any and all necessary repairs to any facility erected or maintained in the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe condition. In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter upon the above-described property of the CITY, the USER shall replace at the USER's sole expense, any and all material necessarily displaced during the action of maintaining,repairing, operating,replacing, or adding to of the utilities and facilities of the CITY or franchise utility provider. The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes, Land Development Code,and all other land use and code requirements of the CITY,including City Code Section 19-7(h)which states"Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but must be replaced with smooth concrete left natural in color so that it matches the • existing and adjoining sidewalks." Page l of 2 • The USER, prior to making any changes from the approved plans and/or method, must approval from the City of Atlantic Beach,Public Works De obtain written discretion of the CITY, be requested to submit as-built drawings ho said lthe change LA USER shall,at the • after the day of completion. thirty(30) days This permit shall insure to the benefit of, and be binding upon; the USER and their respective s assigns. p successors and USER shall meet the terms and conditions of this permit and to all of the applicable State and/or specifications, to include utilities locate requiements and use and CITY laws rights-of-way and other public land. USER further agrees limitations/requirements of public be saved harmless by the USER from any of the work herein under the terms and f this permit that all employees shad liabilities are hereby assumed by the USER. that all of said DATED and SIGNED this J day of 7A A13y _ I' 4•-v a. c..t.c �M� � Property Owner (to be signed in presence of the Notary) STATE OF FLORIDA COUNTY OF DUVAL On this day of and for said County 20 appeared before me, a Notary Public in tY and State, the property owner of Atlantic Beach,Florida,known to me to be the person(s)described in and 'o ex- uted the foregoing instrument; who acknowledged to me that he or she executed the • vol and for the - same freely �,. Purposes therein mentioned. L, Notary Public fo =o��yr Notary Public State of Florida said Co ulty: d State Shirley L Graham c� �� My Commission FF 086990 CITY OF ATLANTIC BEACH, FLORIDA, a 14°;094's Expires 02/14/2018 municipal corporation: App pv : f. Doug La • ,,Public Works Direct, For Permits where city sidewalk is impacted, City Manager approval required: ffi Nelson Van Liere,City Manager I Page 2 of 2 I ,'-;' , /I' F' ,, Comp. By: 4 SRW liar z Date: 5/15/2015 0,3}>r Public Works Department City of Atlantic Beach Permit No: 15-Dway-1133 Address: 235 Ocean Required Storage Volume Criteria: Section 24-66 of the City of Atlantic Beach's Zoning, Subdivsion, and Land Development Regulations requires that the difference between the pre-and postdevelopment volume of stormwawter runoff be stored on site. Volume of Runoff is defined as follows: V= CAR/12 Where: V=Volume of Runoff C =Coefficient of Runoff A=Area of lot in square feet R=25-yr/24-hr rainfall depth(9.3-inches for Atlantic Beach) Predevelopment Runoff Volume: Lot Area(A) = 5,615 ft2 Runoff Coefficient Area Lot Area Description (ft2) (ft2) "C" Wtd "C" Impervious 2,768 5,615 1.00 0.49 Pervious 2,847 5,615 0.20 0.10 Runoff Coefficient(C)= 0.59 Runoff Volume V= 0.59 x 5,615 x 9.3 / 12 V= 2,586 ft3 Postdevelopment Runoff Volume: Lot Area (A) = 5,615 ft2 Runoff Coefficient Area Lot Area Description (ft2) (ft2) "C" Wtd "C" Impervious 2,725 5,615 1.00 0.49 %I SA = 48.5% Pervious 2,890 5,615 0.20 0.10 Runoff Coefficient(C)= 0.59 Runoff Volume V= 0.59 x 5,615 x 9.3 / 12 V= 2,560 ft3 Required Storage Volume DV= Postdevelopment Runoff Volume- Predevelopment Runoff Volume DV= 2,560 - 2,586 DV= -27 ft3 Retention 1639 Sea Oats Drive 15-Radd-1053 5/15/2015 rites''' •, . 0•1. ': Comp. By: SRW ,mow 4, Date: 5/15/2015 Public Works Department City of Atlantic Beach Permit No: 15-Dway-1133 Address: 235 Ocean Provided Storage: Elevation Area Storage (ft) (ft2) (ft3) 0 BOTTOM 0 TOB Elevation Area Storage (ft) (ft) (ft) 0 BOTTOM 0 TOB Elevation Area Storage (ft) (ft2) (ft3) 0 BOTTOM 0 TOB Inground storage=A*d*pf A=Area= 0.0 d=depth to ESHWT= 4.0 pf= pore factor= 0.3 Inground Storage= 0.0 ft3 Required Treatment Volume= -27 ft3 Supplied Treatment Volume= 0 ft3 Retention 1639 Sea Oats Drive 15-Radd-1053 5/15/2015 234 Ocean Existing Footprint Width Length Area LOT 50 112.3 5,615.0 House 21 67.4 1,415.4 House 14.4 32.7 470.9 House 7.2 6.7 48.2 Drive 15.9 24.8 394.3 Front Deck 14 34.7 485.8 Rear Deck- (Removed) -8 17.4 (139.2) Walk 3 31 93.0 Total 2,768.4 49.3% With Proposed Footprint Pervious Credit House 21 67.4 1,415.4 1,415.4 House 14.4 32.7 470.9 470.9 House 7.2 6.7 48.2 48.2 Drive (Paver) 15.9 24.8 394.3 197.16 Parking (Paver) 16 10 240.0 120.00 Parking 2 (Paver) 16 6 144.0 72.00 Front Deck (Wood) 14 20 280.0 140.00 Front Deck (Paver) 14 14.7 205.8 102.90 Rear Deck (Paver)** 15 18 270.0 270.00 Rr. Deck- (Removed) -8 17.4 (139.2) (139.2) Front Walk- (Removed) -3 12 (36.0) (36.00) Hot Tub 8 8 64.0 64.0 Total 3,357.4 2,725.4 Percentage of Lot 59.8% 48.5% Pervious Credit 50% ** Not Permeable (4i, 41(j/1/- 234GOslo' Atlantic Beach, FL 32233 Scope of Work: 1. Remove existing cracked and broken driveway. 2. Remove existing impermeable concrete deck inside privacy fence. 3. Install new expanded driveway and parking area using permeable pavers. 4. Install new permeable paver deck inside privacy fence at front of house. 5. Install new non-permeable paver deck inside privacy fence at rear of house. Norman Gauslow Da. e CITY OF ATLANTIC BEACH WNER / 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, WHICI-I 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 REOUIRED 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. 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(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. AD 23 6t� I✓ 6G Vb • _ 6/3 693--2-7/7 PHONE NUMBER o ,,i 6 e U51-0 Li)PRINT NAM / S zoi S �Z .- SIGNATURE .� ,/ DATE ` Before me this I 2- day of {�4 M/ 20 IS-in 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. 800 x4., Notary Public State of Florida I , Teresa R MacDonald Notary Public at Large,State of FUN-WA,County of I4lU 60tw y p My Commission EE115391 / , ersonally Known Ot��� Expires 07/25/2015 ❑Produced Identification- Notary naTure: � � -.. F:BLDG'Owner-Builder Affadavit;REVISED:4/16/2009 Property Appraiser- Property Details Page 1 of 2 GAUSLOW NORMAN D w Primary Site Address Official Record Book/Page Tile# 234 OCEAN BLVD 234 2ND ST 06041-00074 9416 ATLANTIC BEACH, FL 32233-5226 Atlantic Beach FL 32233 GAUSLOW ELANA A 234 2ND ST Property Detail Value Summary RE# 170197-0100 2014 Certified 2015 In Proaress- Tax_Dict USD3 - Value Method CAMA CAMA Property Use 0100 SINGLE FAMILY Total Building Value $86,486.00 $92,770.00 #of Buildings 1 Extra Feature Value $765.00 $694.00 Land Value(Market) $350,000.00 $350,000.00 Legal Desc. 16-2S-29E -- _ - ATLANTIC BEACH Land Value(Aaric] $0.00 $0.00 -- Subdivision 03101 ATLANTIC BEACH Just(Market)Value $437,251.00 $443,464.00 . Total Area 5583 Assessed Value $368,302.00 $405,132.00 . - The sale of this property may result in higher property taxes.For more information go Cap Diff/Portability Amt $68,949.00/$0.00 $38,332.00/$0.00 to Save Our Home*and our Property Tax Estimator.'In Progress'property values, Exemptions $0.00 !See below exemptions and other supporting information on this page are part of the working tax roll and are subject to change.Certified values listed in the Value Summary are those Taxable Value $368,302.00 See below certified in October,but may include any official changes made after certification Learn how the Property Appraiser's Office values Property. Taxable Values and Exemptions—In Progress 4-A If there are no exemptions applicable to a taxing authority,the Taxable Value is the same as the Assessed Value listed above in the Value Summary box. County/Municipal Taxable Value SJRWMD/FIND Taxable Value School Taxable Value No applicable exemptions No applicable exemptions No applicable exemptions 0 Sales History T Book/Page Sale Date Sale Price Deed Instrument Type Code Qualified/Unqualified Vacant/Improved 06041-00074 11/5/1985 $100.00 WD-Warranty Deed Unqualified Improved 06145-00104 j 6/6/1986 $152,500.00 WD-Warranty Deed Unqualified Improved 07309-00034 4/2/1992 $100.00 QC-Quit Claim Unqualified Improved Extra Features f.} ■ LN Feature ••e Feature Description Bldg. Length Width Total Units Value 1 FPPR7 • Fireplace Prefab 1 0 0 1.00 $694.00 Land&Legal #-.1 Land Legal LN Cede Use Description Zoning Front Depth i Category Land Lind Land 1 LN Legal Description Units MUM Value 1 16-2S-29E 1 0100 ACS LD 3-7 UNITS PER ARS-2 50.00 115.00 Common 1 1.00 Lot $350,000.00 2 ATLANTIC BEACH 1 3 LOT 2 BLK 29 Buildings 4* Building 1 Budding 1 Site Address Element Code Detail —1 r-1 2342ND ST Atlantic Beach FL 32233 Exterior Wall 12 12 Cedar/Redwood 1 . Roof Struct 3 3 Gable or Hip e� I a L_ Building Type i 0102-SFR 2 STORY Roofing Cover 3 3 Asph/Comp Sting L_ I A r Year Built 1986 Interior Wall 5 5 Drywall L I Building Value !$92,770.00 Int Flooring 11 11 Cer Clay Tile Int Flooring 14 14 Carpet L._GJ RI Tvce Gross Heated Effective Heating Fuel 4 4 Electric Area Area Area Heating Type 4 4 Forced-Ducted __ Finished upper 418 !418 397 Air Cond 3 3 Central story 1 Unfinished Garage 504 0 227 Element Code • Base Area 1208 1208 1208 Stories 2.000 Total 2130 1626 11832 Bedrooms 3.000 http://apps.coj.net/paojropertySearch/Basic/Detail.aspx?RE=1701970100 5/13/2015 ,.074!J?:,,- .'o� CITY OF ATLANTIC BEACH • •„` CONSTRUCTION PERMIT WITHIN CITY f����-� . .•-=. RIGHTS OF WAY AND EASEMENTS 800 Seminole Road sv%;lh `•- Atlantic Beach,Florida 32233-5445 904-247-5845 PLEASE SUBMIT COMPLETE SETS OF PLANS WITH APPLICATION. Fax 904-247-5845 Date !3 /c— Job Address ����-� PERMIT# ISSUED BY THE CITY Permitee: PI. C a /L.) Permittee Address: Telephone# a p/ Requesting Permission to Construct: i v 2. Location: (Reference to Cross-Street) 1. Applicant declares that prior to filing this application he has ascertained the loca both aerial and underground and the accurate locations are shown on the ketches lion of all existing utilities, A Letter of Notification was mailed to the following Utilities/Municipalities: Jacksonville Electric Authority Bell South Telephone Company Yes( ) No ( ) Date: Ferrell Gas Yes( ) No ( ) Date: Comcast Yes ( ) No ( ) Date: 2. Whenever necessary for the construction, repair, Yes( ) No ( ) Date: Whenever or necessary for all, or any p , improvement, maintenance, safe and efficient operation, Works, any or all of said poles,wires,np pes,dcables°o easement otherfacilit es and determined appurtenances estor th rued hereunder, shall be immediately removed from said street or easement or reset or.reloca required by the Director of Public Works, and at the expense of the Permittee nle authorized authorized. relocated hereon as 3. All work shall meet City of Atlantic Beach or Florida Department of Transportation unless anda ds and e performed under the supervision of • Superintendent) located at p Standards and be 4. All materials and equipment shall be subject to inspection by the Director (Contractor's Project 5. Telephone#: All city property shall be restored to its original condition as far as practical, in keeping Works cit designee.e t and the manner satisfactory to the city. 6. A sketch of plans covering details of this installation, as well as, a copy city specifications part of this permit. Calculations showin• an increase in im.ervious area on ow Right of Way are to be included with this a lication. py °f a recent survey shall be made a 7. This permittee shall commence actual construction in good faith with owner's lot or in the cit more than 60 days from date of permit approval, then permittee must review the permit with the Director__• days. If the beginning date is 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 e 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 B the extent of the r will, at all 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. each from and 9. The Director of Public Works shall be notified twenty-four (24) hours prior to starting immediately upon completion. g work and again OWNER Date:I / g° IS? i ne•. !�. ..Before •-thi day of St. �•f Flor'.a,has p r ipeered —in th- - • • '• - Pub' of Lars ,pers.s lirk lorida,County of Duval. ry Public State of Florida N. ••m n exp'es: Shlrlea�y L Graham• •, eti0 /14/fI�FfCQB®N90 0'F = ntidap(r � /14/2tl18 1 ", �.t , x,, -:-----‘ e is i'',....:: •�._ .I,,••t 3y - ._ u . a pc \ a v C * • • N 14 a Cn x b a ati .o lab (in-E, .E. ® l ■ V O m W H : 1 v O ° a ”C) y CO o 4 o� '..a. O n +m 0 D a - a 0 \ \ y a 'd = f x x x j 3 a Q � � N x u W y IX W V so ,p O^ �+ d W g W x x x S 9 Fib ?, a - rO 70 ..= M .O so. U 0 C o u a O W a o C d o •4 Li a .1",3 Q W m a 3 W C.> c v p a 0- - .o Co 0"!19"Q 003 Cy RcY �Jq�/ VI tFl C7 . . �t i + L l� ,'- Cl"ti 41 11 s '� �' -•et a•. •. t 8, i r a Atilt y. ■ { cq INVIIIIIr d I /+ \'., M f a) 1 y E. i . ,. . .1._. . 1 ' ti { „ I) Ili •' • 00 • _ } P N• r to ' ,/ c • . r / C� . �� «. AA ►".1'�# ' { C Ci cn a, �` . i4 �' ' . ' r VI ' • 'i it7.11/, , E IA! ' 1' ' s , OD .b ? r "1 o '1 ' ti O ; C''". cif 4" O C m N N ° o N CD Ca. 0 a 3 w� N 0 jy C ^ N 7 r^ Q V� m Q U ..y N CA •r E Co) N _M W kri 00 N v) r- aj N N VD CIN M CEO N N N M @\j VI Q U C7 q,Bc in 7 LL N C 03 W O ' m m m N a cn pS M ehe.N fi '1 Cit of Atlantic Beach ya'-"i' j1,: y APPLICATION NUMBER i�1 Building Department RI ' PPTED1 (To be assi n by the Building Department.) i" `� 800 Seminole Road � ']��,�� �� }�'� Atlantic Beach, Florida 32233 5445 MAY 1 Z(111� 1/33 ?� / Phone ���� hone(904)247 5826 Fax(904)2 i 6–;t�� ' E-mail: building-dept@coab.us BY Date routed: City web-site: http://www.coab.us .—__. APPLICATION REVIEW AND TRACKING FORM Property Address: C)3 1/ O2 L Department review required Yes No Applican • 6 ti)-)-1 E.4, — (---. Planning &Zonin ✓' Tree dministrator Project: AV� I � 7fto ublic Worl u c Utilities Y • i 14 fiJ 7 Public Safety / Fire Services Review fee $ 2 S— Dept Signature `)<t•"--- Other Agency Review or Permit Required Review or Receipt Date of Permit Verified By Florida Dept. of Environmental Protection Florida Dept.of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Restaurants - Division of Alcoholic Beverages and Tobacco Other: APPLICATION ST ATUS _ Reviewing Department First Review: Picpproved. ❑Denied. (Circle one.) Comments: BUILDING r PLANNING&ZONING Reviewed by:5 ,- c-------- ✓51 Date: "!'l TREE ADMIN. Second Review: ['Approved as revised. ❑Denied. •41 1VC►WOR a mments: :LIC UTILITIES IC' PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 07/27/10 ,s ,. City of Atlantic Beach Building Department RECEjVEjj_ APPLICATION NUMBER (To be assi n by the Building Department) 800 Seminole Road -- } Atlantic Beach, Florida 32233-5445 MAY 1 4 2015 /6 .4 Phone(904)247-5826 • Fax(904)2 7-5845 33 1.Olil',: E-mail: building-dept @coab.us BY:.---web-site: http://www coab.us �---- ___1 Date routed APPLICATION REVIEW AND TRACKING FORM Property Address: 3 d O C C nil _ Department review required IMMI No Applicant• _ U W -1`-. . Planning &Zonin Tree a dm" �- Pro'ect: V� ,/' m�strator MI Project: r s j�, d �blic Wor _ i 2?y I V vt) i3 Public Safety _- Fire Services Review fee $. _ Dept Signature Other Agency Review or Permit Required Review or Receipt of Permit Verified B Date Florida Dept. of Environmental Protection Florida Dept. of Transportation St.Johns River Water Management District MIIIIIIIIIIIIIMMIMMI Army Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review: ❑Approved. (Circle one.) Comments: Denied. BUILDING �EE , ,f�r4� w��1 1 PLANNING&ZONING Reviewed by: _KV,..m..m �_ TREE ADMIN. Date:�i Second Review: Approved as revised. II Denie PUBLIC WORKS Comments: lc e ` Cow4v4t PUBLIC UTILITIES a/7 /J PUBLIC SAFETY Reviewed by: J/ -m _— --- - Date: FIRE SERVICES Third Review: ['Approved as revised. Denied. Comments: Reviewed by: Date: Revised 07/27/10 1