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132 BELVEDERE ST DETACHED SHED APPLICATION JPhone City of Atlantic Beach APPLICATION NUMBER Building Department (To be assigned by the Building Department.) 800 Seminole Road �^CCAtlantic Beach, Florida 322335445 �z�1..�� — IS(Dti (904)247-5826 Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: City web-site: hftp:/Avww.mab.us APPLICATION REVIEW AND TRACKING FORM Property Address: ►3a tf_1V(.D-l..f L S-k 1 Department review required Yes No wilding Applicant: 'l\q�Sp MCSannl g&Zoning mis ra or Project: Public Works ub is tilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B Florida Dept.of Environmental Protection Florida Dept.offnansportation St.Johns River Water Managemem 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 PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: 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 06/14/09 Rj2 BUILDING PE Tf PPI1ZAlTOI� CITY OF ATLANTIC BEACH 800 Seminole Road,Atlantic Beach FL 32233 ort py Q Office:(904)247-5826 • Fax:(904)247-5845 Job Address: I .� � �elue�Ilce �� Permit Number: Legal Description Valuation of Work(Replacement Cost)$ q aZ�Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): Iew Addition Alteration Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial Gzab • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No /A • Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail the type of work to be performed: I Florida Product Approval# for multiple products use product approval form Property Owner Information p _1 Name ` S`ty Address: I J� Olt\Ve&('P S� City 1. State fL Zip 31�3_�phone 311 - 331 '6l ); E-Mail 1 _AMA .train OWner OIAgeat (aAgrnt,Powcof Ammayor Agency LetterRcywredl 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. Contractor Information: Name of Company: •d air - .%n �Sftc/C,,�t, Quali n gent: 1-frtr' fK-t Address: 0 K /P ' . ! City�z , _State Zip 7 ?R Tr Office Phone R ct Number State Certification/Registration# C CC nzt8oc,3 E-Mail :a /yt rw�rC•r{.Oct Architect Name&Phone# Engineer's Name&Phone# Worker's Compensation cxemp[ I 111mumr 1 Lcoic Employees , Expiation Due Application is hereby made to obtain o permit to do the work and installation,as indicated I certify that no work or installation has comm or to the issuance ofa permit and that all work will be performed to meet the standards ofall laws regulating routmctlon in iho,co adiction is permit becomes null and void if work is not commenced within six(6 months, or if construction or work u suspe ded or abandoned(ar a period olZ(6)monthsatany time after work isrommenced. Iunderstandthatsepamiepermimmustbes mdfor B(ecokid Work,Plumbing, Signs,tYeLs.Poa/s,Purnoces,BollesQHgealem /Tine klsland Air Conditioners,e!c Signature of Prop Owner: MA& Signature of Contractor: Bea me this t l Day of J [) Before me this Day o TOM GINIXElPERG Notary Public: MYCOWA LM%I No 3''rat,h Arvrawwucuwnnun G1 ER '' MYCO MISSION/FF22M ordinances cent that I have read an rxami l is pplication and know the. 3ra� gjtgg�s$Qdprot i f laws and ordinances governingg/his type o(work will a complied with whether sped Wd fn�ppseoaawwm/ Vermlt does not presume to give outhority to violate or cancel the provisions of any other je a etevinstructiarc or the performance ofcomtruchon. 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