645 Plaza 15-RADD-1950 i I 'Lyr
r� '\ s„ CITY OF ATLANTIC BEACH
K .. A 800 SEMINOLE ROAD
N, ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ADDITION
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-RADD-1950
Job Type: RESIDENTIAL ADDITION
Description: NEW PORCH ADDITION, SIDING, METAL ROOF, INTERIOR
RENOVATION
Estimated Value: $10,000.00
Issue Date: 9/8/2015
Expiration Date: 3/6/2016
PROPERTY ADDRESS:
Address: 645 Plaza
RE Number: 171218-0000
PROPERTY OWNER:
Name: CROSSMAN, DIANNA N
Address: 645 PLAZA
GENERAL CONTRACTOR INFORMATION:
Name: BROADWELL BUILDERS
Address: 335 COUNTRY CLUB LN JOHN PATRICK BROADWELL
Phone: - -
PERMIT INFORMATION: PUBLIC WORKS:
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.
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.
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.
IFFkg§`IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND 171E FLORIDA
BUILDING CODES.
y, s,, CITY OF ATLANTIC BEACH
f, ...:a 800 SEMINOLE ROAD
j ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
\J;ii r):
STATE DCA SURCHARGE $2.00
STATE DBPR SURCHARGE $2.00
BUILDING PERMIT FEE $100.00
PLAN CHECK FEES $50.00
Total Payments: $154.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WIFFII ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
1..-y
BUILDING PERMIT APPLICATION OFFICE COPY
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904) 247-5845 1 5-k O D-(9s O
C ��/
Job Address: uZ�1 ��f�C � /�� . 3,?,?3 Permit Number:
Legal Description Parcel #
Floor Area of Sq.Ft. q, t
Valuation of Work$/O,OCO Proposed Work heated/cooled non-heated/cooled%:28
Class of Work(circle one):
0
Additio Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s)(circ e one): Commercial 'esidentia _
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: �c p 1c,c C- f►•t-che...) c c...L 1,,e' s y hoc ri',c%5 1
L CA-, SI J CiN petrtial Of 6k4.0/Cor 4hj v-ed 71;"‘-,A...f /arch
Property Owner Information: // /�� J
Name: %:,.+vr A_rel l 1/.N�' rl kit C/5 Address: /10 7 S(4-7(',vo/ i
City 4/4„v7//e hd , L StateJJZip 3,,?33 Phone 706, -6S -*24'
E-Mail or Fax#(Optional) J
Contractor Information: CONTRACTOR EMAIL ADDRESS: -,r6c d h;, ,1 i d c Cc►-kco4T.t0ET
Company Name:BRO!}O EU.S 13UTL0E* . Qualifying Agent- PYrstrea(3. pKO6 WEs4..
Address:335 Goo-co Cwd L.0 City AT1-a"T . goal/ State ft- Zip32233
Office Phone els-56,97 Job Site/Contact Numb,— (,54. 424¢ Fax# 211-2843
State Certification/Registration#m- 125732 S
Architect Name& Phone# Pir('altac 2 QRmAONA — 8c3 1.497
Engineer's Name &Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated. 1 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 this jurisdiction. This permit becomes null
and void if work is not commenced within six(6)months, or if construction or work is suspended or abandoned for a period of six(6)months at any time after
work is commenced. I understand that separate permits,must be secured for ElectricalWork, Plumbing,Signs, Wells, Pools, Furnaces, Boilers, Heaters,
Tanks and Air Conditioners,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 I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinan^es governing this
type of work will be complied with whether specified herein or not. The granting of a permit does not presume to , ut,i it to. rte or cancel the
provisions of any other federal,state, or local law regulating construction or the performance of construction. f;
Signature of Owner Signature of Contractor IrI�.`� �� v
Print Nai e tcj s 1z, W;J 1 •C , it- Print Name Pitt• 'is ', egoA>flWer1-
Befo • �r,- / •
j Befor ---
th . Day .f ai J. . �• 20 _ , /+4
his Day �. r.,��,�',.• •_.• ����+��,)
Pler4
��= Public State of Florida
bli 4ry
°' ' u! IC ��ep Notary Public State of Florida Notary P bIi iliga&ptres 02/14/2018
• Shirley L Graham
'Ter • ExpiCro 02/14/2018 068990 evise! 11.26.10
rm; S'-gnOD /9S0
NOTICE OF COMMENCEMENT
OFFICE FICE COPY
State of fk 1'7 County of O�v G�\ Tax Folio No.
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713 of
the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMET.
O
Legal Description of property being improved: 3 U-( /r? -,?S— <,1 y U ye / /-:,/.41 0�, f
•
Address of property being improved: 6 VS' /A u1 / ,4714.--,i'c .& 1' •, , Z )3v?,?33
General description of improvements: `i/eh(A C,u1/'tiC , •f/OUrIj) / /hetebet/ LG,r .Sj�i`.►x{
7AI C cric,'J 7C; Oj,,YL Isar+cA "`i//tom,c tit/ rc)o �clr<‘41'c,.�.) U•..i Ar'.kc /63N
Owner: ��'c►-cilit I A✓i. 7t4Y i/ a1L Address: /20'7 Se's -, vok R . &�2 �G
,
Owner's interest in site of the improvement: 3 o? 3,3
Fee Simple Titleholder(if other than owner):•
Name:
/Contractor: PA MCA( If3 Ro' DWALL
Address: 335 Co&,,e1 i C4-0a t.in) riAsiTJr-- AWN Ft— 32233
Telephone No.:(904) 5)3-5(.97 Fax No:(904) 241 - 2.8 23
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of Florida, other than himself,'designated by owner upon whom notices or other documents may be
served: Name:
Address:
. Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different ..tai is
specified):
ts
:a t LL 0
O
THIS SPACE FOR RECORDER'S USE ONLY OWNER 0
\ ' •a» E0
Signed: . . l . !�,��t• Date: / / `t°ro
Before me this `j day o •,!i,./ in the Cou ty of b uval, •t
Of Florida,has personally .speared
Personally Known: °'ro�
�
Produced IdentificatioW—'- �
n Q
Notary Public: c,.tee°
My commission a .' _.
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
p�
Office (904) 247-5826 Fax (904) 247-5845 15-k k bD-rj s O
Job Address: 6 V> Pht zCL /�4/k ) /—� . 3;03:3
i Permit Number:
Legal Description Parcel #
Valuation of Work$/UO Floor Area of Sq.Ft. Sq.Ft
! Proposed Work heated/cooled non-heated/cooled/08
Class of Work(circle one): CP Additio Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed struct ire(s) (circ a one): Commercial
If an existing structure,is a fire sprinkler system installed? (Circle one): es' shia;o N/A
Florida Product Approval #
For multiple products use product approva form
Describe in detail the type of work to be performed: �9 \&u.(,- , t‹.I,,,u b ;7,0;10_51
C"� /.�c S j
Lap SiL i c■■ parhett of ejf-tirivr, 4i ',j cv tier ed 1r0.(....71 ,4re`7
Property Owner Information:
Name: ,:47 nicrdkG/Aio l rii// V
i c
Address: /)07 s�/Y/.',uWe /4/City . f‘14,-//e. /LA %r L. State, Zip 3J33 Phone Y0 z/ -6-s‘1°Ywy E-Mail or Fax#(Optional)
•
Contractor Information: CONTRACTOR EMAIL ADDRESS:broad bw 1 ICI L co�
n c•��7.tJI:T
Company Name:BRO1%c t.)611:S 130 LDEQS C. Qualifying Agent. RVfl rele 3-. P0e0 wEi.L.
Address: 335 Coo.o.my C•cwd L.0 City /hT'-*'TrL i,aikH
Office Phone $13 5697 Job Site/Contact Numbs State 1[. Zip 322/3
State Certification/Registration#C( 1257323 3�-4244' Fax# 2�1-28Z3
Architect Name&Phone# P/rtia 2: QRaaAt„__ $t3.slog 7
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain a permit to do the work and installations as indicated 1 certify that no work or installation has commenced prior to the
issuance if work isJnot commenced within six performed 6)months, or connstruction or of all is suspended or abandone id for this pejurisdiction.d of i (6)months attany time after r
work is commenced I understand that separate permits must be secured for ElectricalpWor/r, Plumbing,Signs, Wells,Pools, Furnaces, Boilers, Heaters,
Tanks and Air Conditioners,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.
hereby ertify that I have read and examined this a placation and know the same to be true and correct. All provisions of laws and ordinances governing this
)pe of work will be complied with whether specs ted herein or not. The granting of a permit does not resume to • - •ut,,
2rovisions of any other federal,state, or local law regulating construction or the performance of construction. r to to or cancel the
signature of Owner _ Signature of Contractor Irm .`� (f6\)
'rintNat4e �\ /:�� np
�.cic C, e-C(�, X_ Print Name Par' 'z , IJROA01.01-L-
tefo- r
Day �I J
20 _ ;this Day •• ,,!ti:_+! U•
il Nik fig9r4 _ _ n=ry Public State of Florida
.tom. . .�__:::,_ ... �.
•°--°! U 1C ♦To No A -y L Graham
: Notary Public State or Florida r � ^.+ .�r�.c.r.u.r
Shirley L Graham Notary P bli *plies 1 6,F 02i14/2018
My Commission FF 086990
o>wo Expires 02/14/2018 evise 11.26.10
Orr earl2wil‘S
r ZONING REVIEW COMMENTS
J \js1
City of Atlantic Beach
, �r Building and Zoning Department
800 Seminole Road Atlantic Beach, Florida 32233-5445
i J;3 Jr Phone: (904) 270-1605 Fax: (904) 247-5845 Email: dreeves @coab.us
Date: 8/26/15
Permit: 15-RADD-1950 Applicant: Broadwell's Builders
Review: 1st Address: 335 Country Club Ln, Atlantic Beach, FL 32233
Site Address: 645 Plaza Phone: (904) 813-5697
RE#: 171218-0000 Email: broadbuild @comcast.net
Correction Comments
1. Survey: Please provide a legal survey.
2. Tree Removal: Please submit a Tree Removal Permit Application if any trees are to be removed. If no
trees are to be removed,then please fill out an Affidavit of No Tree Removal. Both forms are available
on the city website under "Planning and Zoning" and at City Hall. Also please be aware that codes
have recently changed. If you are unsure about how the new codes effect your project, please submit a
Tree Removal Permit and staff can then determine if it is necessary.
Derek W. Reeves
Planner
dreeves @coab.us
•
NOTICE OF COMMENCEMENT
State of 1C/0 r ila County of
Tax Folio
11� No.
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713 of
the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: 30 60 / Ro ye / /-2c1,-1 OA)i f
•
Address of property being improved: 6 /-S' /?/a ze, 4114,- h , f'Z 32,733
General description of improvements: 1)".;/(46...i C.0 ;�e./i11 .1?UU;_A,��j / / k vA,,„ ) Al 5 '1.o
Al 1 ff,� / ll �a/rCA ti, 2</ ucv c�cl � �� (�ti//ie� 1-cGI /637tT
Owner: 44✓ul1)`q / ,tJi lib,/ Ai atc/5 Address: / O i7 Sewic vv/e ,? . /��/ �.G 4.1-
GC j /G
Owner's interest in site of the improvement: ' f 3 a,73.7
Fee Simple Titleholder(if other than owner):•
Name:
/Contractor: Pk1R.jc(, J, E R0A D Ii
Address: 335 Coi 1 i (a' ,Jd 1..00 T1q-.,TJ>✓ (BRCH Ft-. 322:33
Telephone No.:(904) 313"5`97 Fax No:(904.) 24) - 2 8 23
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements •
Name:
Address:
Phone No: Fax No:
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other documents may be
served: Name:
Address:
. Telephone No: Fax No:
In addition to himself, owner designates•the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different :.�is g
specified): a o
c Lt.o
TATS SPACE FOR RECORDER'S USE ONLY OWNER
g�p
1a
0.
Signed: 1 . 1. Date: j / — z v o
Before me this ��j' day o (ad,./ in the Cou ty of uval, t
Of Florida,has personally.speared �i •
Personally Known: Air ►v,�
Produced Identification"WMF,
Notary Public: i'�--.
My commission e .' _ %t�l/j���i�ii
r r,, TREE & VEGETATION AFFIDAVIT
"` �S City of Atlantic Beach
;4. ) Department of Community Development
1r Planning&Zoning Division
800 Seminole Road Atlantic Beach, FL 32233
�0"" (P) 904 247-5800 (F) 904 247-5845 PERMIT#
SECTION I-APPLICANT INFORMATION I- Owner(s) x Legal Authorized Agent*
NAME OF APPLICANT Patrick J.Broadwell
NAME OF COMPANY Broadwell's Builders Inc.
ADDRESS OF COMPANY 335 Country Club Ln.
PHONE 813-5697 CELL EMAIL broadbuild @comcast.net
CONTRACTOR CERTIFICATION NUMBER CBC-1257323
ATLBCH BUSINESS TAX RECEIPT NUMBER 641294.0001-0001 H08
SECTION II-SITE INFORMATION
STREET ADDRESS OF PROPERTY 645 Plaza Atlantic Beach,Florida.32233
If an address has not been assigned to this property,contact the AB Building Department at(904)247-5826 to request an address.
LEGAL DESCRIPTION 30_Co 1-7. 25 - 29L IOY/L Pfft_n S Un)S r 0 f
LOT BLOCK SUBDIVISION (Sill L I'"AL-i"t5
REAL ESTATE NUMBER 171218-0000 LOT OR PARCEL SIZE: -7 81_, SQ FT AC
RESIDENTIAL x COMMERCIAL OTHER(SPECIFY)
1 affirm that I have reviewed the provisions of Chapter 23, "Protection of Trees and Native Vegetation"of the Municipal Code of
Ordinances for the City of Atlantic Beach, FL and/or I have participated in a pre-application meeting with the Administrator of those
regulations. Subsequently, I affirm that no regulated trees and no regulated vegetation will be damaged, destroyed and/or removed
from the above-described or adjacent properties in conjunction with this project. I , . c t IVIV
SIGNATU OF OWNER SIGNATURE OF OWNER
Signed and sworn before me on this 2Sday of A.`l5u 5 f , 2O/ ,by State of nog , Dv9
JQaj& W • 6/0 6-
`$R . 7] County of V CA 1/aL
Identification verified: FL. pL 6/ 30 1 ? 9 (0, 'f 2q7 U
Oath sworn: I__ Yes ( /-.No
u, L., e . _
Notary Signature °o r Ni,e Notary Public State of Florida
Nancy E Bailey
REV-TVA-v10.12 My Commission expires: '+a,�o�� Expires 02/08/20EE 156116
MAP SHOWING SURVEY OF
LOT 33 BLOCK 5 ROYAL PALMS UNIT ONE, AS RECORDED IN PLAT BOOK 30, PAGES 60 AND 60A, OF THE
CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
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LAND & HYDROGRAPHIC REGISTERED SURVEYOR NO. 1674 FLA.
_SURVEYORS �/
POST OFFICE BOX 30670-� SIGNED LIU!•[/ 7 /7'
$B BTii STaE�j Sn�.,-„ 7 19?Z
JACKSONVILLE BEACH, FLA. SCALE: / I�= ZO
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ORDER NO. ._ Go.2B3
C Nr City of Atlantic Beach t`, Building Department APPLICATION NUMBER
800 Seminole Road
(To be assigned by the Building Department.)
s) Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 Fax(904)247-5845 / .5
�' E-mail: building-dept @coab.us Date routed: r)/(7
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: G4 Cj P L{-zc\ Department review required Yes No
B*0 uil din _
Applicant: P1/4 (A)�L�S BU(LDGp$ Planning &Zonings')
ree Administrator
Project: (Yc 0 f■ - I Iv Tea(0 CZ-- Pucks
Reroo'.f ATt 0 N • ' Utilities
Public Sa ety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified By Date
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 STATUS
•
Reviewing Department First Review: f]Approved. jkiDenied.
(Circle one.) Comments: f /144c tLe_
BUILDING
PLANNING &ZONING Reviewed by: y'7,' Date: G/ /s
TREE ADMIN.
Second Review: gApproved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:�6V:".,__---"Date:
FIRE SERVICES Third Review:
ew: DApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
evised 07/27/10
.
•
-0,1- r:r City of Atlantic Beach APPLICATION NUMBER
t • ' to Building Department (To be assigned by the Building Department.)
1 Atlantic tic Seminole Road _ R ( -1950
�� - �� Atlantic Beach, Florida 32233-5445 I-{
Phone(904)247-5826 Fax(904)247-5845
' 01/39 E-mail: building-dept @coab.us Date routed: (G f 7 A5
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: G4 Cj PLAZA Department review required Ye No
41 Building.
Applicant: C)Pkb(A)6 (.___5 BU((,bE12S �r lannin 9 &Zoning
Tree-Adminis ra or
Project: bb (Y/ f� — ( N '�C--12(p(L � Pu. • A irks
R;;�� 41 •' • • Utilities
c fco'J{ai 0 /� - - r Public Safety
bit,/ _ fitera oOServices
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B y _
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 STATUS
Reviewing Department First Review: Aproved. !Denied.
(Circle one.) Comments:
UILU
PLANNING & ZONING .1 5—
Reviewed by: Date:
•
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑Deni•::.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 07/27/10
4%r"lea tr- /9ra
44/- /oo)(A = �D90
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J9142 4 3lZ N
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ot.iukr City of Atlantic Beach ,
,v>1 Building Department V
(To be assigned by the Building Department.)
APPLICATION NUMBER
800 Seminole Road
Atlantic Beach, Florida 32233-5445 J6 1 7 201, 15- R ROD -19 S O
Phone(904)247-5826 Fax(904)247-5845 ''
9' E-mail: building-dept @coab.us Date routed: (-)/f 7L5
City web-site: http://www.coab.us `_ G
•
APPLICATION REVIEW AND TRACKING FORM
11 Property Address: G4 cj P L De•artment review required Yes No
Buildi
B..(W)R.A pplicant: (� A.10 �S BO(Lb&�S „Planning &Zoning
ree Adminis ra or
Project: (� ('T D rks
_P_u lic Utilities
R`cl..)0' 71 0 N Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified By Date
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 STATUS
Reviewing Department First Review: [Approved. ❑Denied.
(Circle one.) Comments: IL€ f ,J `O/J lt44
BUILDING
PLANNING &ZONING
Reviewed by: Date:
TREE ADMIN.
Second Review: FqApproved as revised. ❑Denied.
PUBLIC WORKS Comments:
A—177:#(4-'c) �vY►�--u�%�C
P IL U I ILITIES
PUBLIC SAFETY Reviewed by:/-2. Date: e'/,°-J
FIRE SERVICES Third Review: ['Approved as revised. Denied.
Comments:
Reviewed by: Date:
evised 07/27/10
City of Atlantic Beach C' APP
• Building Department �jT APPLICATION NUMBER
hi 800 Seminole Road 406 a (To be assigned by the Building Department.)
�- �, Atlantic Beach, Florida 32233-544 ; ?4 1 5 is- R KID D 19 SO
Phone(904)247-5826 • Fax(904)247-5845 /L.5
E-mail: building-dept coab.us Date routed: �� 7
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: G S PL1-z Department review required Yes No
/ �uildin
Applicant: B p fkQ(AI L B 0 C,DG2S Planning &Zoning---)
e Administraror
Project: ( �� (Yc p - ( (v Teat d CZ-f Pu• • £ irks
DOv.{-7!O/� , ; Public Safety
l� Public Safety
Fire Services
Review fee $ Dept Signature
Agency Review or Permit Required Review or Receipt
of Permit Verified By Date
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:
APPLI ATION STATUS
•
Reviewing Department First Review: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING /7 ! / Vt �_
Reviewed by: Date: 6 d/t/Ii-
TREE ADMIN.
Second Review: °Approved as revised. ❑Denied.
Opt: C ORK Co ments:
1 uB,y
PU:LIC SAF T Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. °Denied.
Comments:
Reviewed by: Date:
evised 07/27/10
sjrLrf rJ 'c. ZONING REVIEW COMMENTS
City of Atlantic Beach
Building and Zoning Department
800 Seminole Road Atlantic Beach, Florida 32233-5445
Phone: (904) 270-1605 Fax: (904) 247-5845 Email: dreeves@coab.us
Date: 8/26/15
Permit: 15-RADD-1950 Applicant: Broadwell's Builders
Review: 1st Address: 335 Country Club Ln, Atlantic Beach, FL 32233
Site Address: 645 Plaza Phone: (904) 813-5697
RE#: 171218-0000 Email: broadbuild@comcast.net
Correction Comments
1. Survey: Please provide a legal survey.
2. Tree Removal: Please submit a Tree Removal Permit Application if any trees are to be removed. If no
trees are to be removed, then please fill out an Affidavit of No Tree Removal. Both forms are available
on the city website under "Planning and Zoning" and at City Hall. Also please be aware that codes
have recently changed. If you are unsure about how the new codes effect your project, please submit a
Tree Removal Permit and staff can then determine if it is necessary.
Derek W. Reeves
Planner
dreeves@coab.us