720 PARADISE LN SITE CLEARING • / ' r lji
J sd
CITY OF ATLANTIC BEACH
v~ 800 Seminole Road 904 - 247 -5800
03119%- 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, of 3t
Date 4 2..-71/e0
/PERMIT #
Job Address 7 /1 =� S L ISSUED BY THE CITY
Permitee: ��i ri r1 _.... a ►/ . a. C- k Telephone # 4/0 'v Z t ' .02 7
Permittee Address: /s B/V s # Li s
•
Email Addressr . S a . ► , • ' IS e e 11 r1 . 0 ,i Fax Number: Lieii Requesting Permission to commence site development involving the following activity: ie /t/jr /i
Location: (Reference to Cross - Street)
The following permits have been submitted 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 (Contractor's
Project Superintendent) located at Telephone #:
4. Calculations showing anv increase in impervious area on owner's lot and / or in the city Right of Wav 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 u • . - completion.
OWNER •
Signe. • • Date:
Before me ' 1 • ay of ({,�n. /. to/ iin the County of Duval,
St - -r'' lorid. , has personally ... - , red Y
- Public a Large, • ate ookt da, County of Duval. j
My ci ss a -xpire ' T JP • - • .I
— .w . . .4 J► `_" ' ro• uc: • I. n ifi ion:
;oS i , ,,„, Notary Public State of Florida
• Shirley L Graham
•, . v My Commission FF 086990
i " 4 0T to Expires 0211412018
I
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1..upr,,, City of Atlantic Beach I ����
■
fs 411- .� B D APPLICATION NUMBER
' (To be assigned by the Building Department.)
Ir
~ ` '` �� 800 APR 28 2016
1, , Atlantic Road
Beach, Florida 32233 -5445 / " S,/'6 - 20
Phone (904) 247 -5826 Fax (904) 247 -58f§y.
„. -_), E -mail: buildin dept @coab.us - -�_� Date routed: i
City web -site: http: / /www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 2-0 , /trQ, 44,15 `A Department review required Yes No
Building
Applicant: 1 `/ /% A ; ♦ i , . a , Planning & Zoning
Tree Administrator
Project: • _ i . a _ blic Works
7X I / Public 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
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: / Approved. ['Denied.
(Circle one.) Comments:
BUILDING 41 44 h4 6!44
r
PLANNING & ZONING Reviewed b r ` ��
ate: _! "7�
TREE ADMIN. Second Review: 1 A roved as revised.
pp ['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
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