730 PARADISE LN SITE CLEARING t 1 -u-1
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f — CITY OF ATLANTIC BEACH -
800 Seminole Road 904 - 247 -5800
01119r Atlantic Beach, Florida 32233-5445 Fax 904 - 247 -584
SITE DEVELOPMENT PERMIT (for filling, grading or topographically altering land)
PLEASE SUBMIT (2) C MPLETE SETS OF PLANS WITH APPLICATION. 1-�i 3
i /
Date 21 Hp
/ / PERMIT #
Job Address 7 3-6 ?�a £' L7 ISSUED ISSUED BY THE CITY
Permitee: tea' n • 4 elephone # 90 4 1 �p2 6 6 1 4 1
Permittee Address: • AY Ar • vd 4r 24
Email Address raloA••bI(ek • dAvis i y rnin`1 co iti Fax Number:
Requesting Permission to commence mmence site development involving the following activity: ID T eig ryif
Location: (Reference to Cross - Street)
The following permits have been submitted x Tree Removal
Demolition
THIS APPLICATION INCLUDES ALL INFORMATION REQUIRED BY THE CITY'S SITE DEVELOPMENT PERMIT
CHECKLIST (Must be signed by Applicant)
1. Applicant declares that prior to filing this application he has ascertained the location of all existing
utilities, both aerial and underground and the accurate locations are shown on the sketches.
2. Any work proposed in City rights of way or easements shall be subject of a separate Right of Way and
Easement Permit Application.
3. All work shall meet City of Atlantic Beach, City of Jacksonville or Florida Department of Transportation
Standards and be performed under the supervision of
Project Superintendent) located at (Contractor's
Telephoe
4. Calculations showing any increase in impervious area on owner's lot and / or in the city Right of Way are to
be included with this application.
5. All city property shall be restored to its original condition as far as practical, in keeping with city
specifications and the manner satisfactory to the city.
6. This permittee shall commence actual construction in good faith within days. If the beginning
date is more than 60 days from date of permit approval, then permittee must review the permit with the
Director of Public Works to make sure no changes have occurred in the area that would affect the permitted
construction.
7. The Director of Public Works shall be notified twenty -four (24) hours prior to starting work and again
immediately upon completion.
OWNER
Signed: Date:
Before me this day of ' ,.- Zs/ the County of Duval,
State Of Florida, has p- ally appeared _ /
Notary Pu.lic at Lai - • ate o Iorida ou r Duval. •
My com :fissionexpires:1 • 1 ® Personall n•
•
JPA .L •roduced ldentificati. :
x 0 4 0 ° ui Notary Public State of Florida
fk, Shirley L Graham
°a - . _ o My Commission FP 086990
14 0iFtd ►` Expires 02 /14/2016
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/LAn City of Atlantic Beach t APPLICATION NUMBER
Department � � t � 1 '
t ,� Building De p r�j`j
r (To be assigned by the Building Department.)
J ''' . ii: 800 Seminole Roa _
,,, ;r Atlantic Beach, Florida 32233 -5445 APR 2 8 20 i‘' c/ /if/ 7Z - 2 1
. Phone (904) 247 -5826 Fax (904) 247
\ \Q, 1 3 1 110./ E-mail: building-dept@coab.us • Date routed: (o/
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 2'I /yi o • S l - 71 Department review required Yes No
Building
Applicant: L-- n 9 ' C / IA , 1ders Planning & Zoning
Tree Administrator
Project: _ 1 � ai
P�
bi- v u Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
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
Y p 9
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: /Approved. Denied.
(Circle one.) Comments: -46 60t4e4 BUILDING #i*Und
`
PLANNING & ZONING /
Reviewed by 7 / li ate:„.{=',`4
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. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09