620 ORCHID ST - RETAING WALL it\'‘'% City of Atlantic Beach APPLICATION NUMBER
41 `, Building Department RECEIVED (To be assigned by the Building Department.)
800 Seminole Road / � �^
u • �,- Atlantic Beach, Florida 32233-5445 MAR 1 1 2016 1 1 G, '.� EC-K`� `--�1
Phone(904)247-5826 • Fax(904)247-5845 22 /
' .';011ity. E-mail: building-dept@coab.us j BY: Date routed: <Di I b/1 Co
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 6 ZO EF QA-{ (c. S T De.art I ent review required Yes No
�-� :uildin.
Applicant: �JCD 1•)(% rl cG d0 C. t t�(, •:r_ ping &Zoning
tr
\^ ree Adminis ra •r
Project: z
�� R �,'T'j-� lv
-I (ll�C lic Works
u is Utilitie
.c Safety _
Fire Services
Review fee $ Dept Signature .,_4::_,,,. s____
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By j
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 TION STATUS
Reviewing Department First Review: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by:__Sy 14 c------ Date: ?hill t
TREE ADMIN. Second Review: A roved as revised.
❑ pp ❑Denied.
'will IC WO'KS Comments:
0 7 ..e-ef—,
Off-UJILIC ILIT
PUBLI
AFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ['Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
`,-51,�',i , City of Atlantic Beach APPLICATION NUMBER
/J s Building Department y�T� Tl (To be assigned by the Building Department.)
800 Seminole Road . V 1 _ E-CK_S Q 9
=' rte. Atlantic Beach, Florida 32233-5445 ��.� v
Phone(904)247-5826 • Fax(904)247-584MAR 1 1 2016 2/i( b 1i (p
-O 9• E-mail: building-dept@coab.us Date routed: J
City web-site: http://www.coab.us IRY.
APPLICATION REVIEW AND TRACKING FORM
Property Address: 6 ZO 0 RCN t ( Dep ent review required Yes No
, uildin
Applicant: 3o N( ‘ El — P0. t ib Hing &ZoningTh
ree Adminis ra or
r` v V A L,L, lic Work
Project: ,3 Z z—_,--r A l AA ll�C u is Utie
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:
li APPLICATION STATUS
Reviewing Department First Review: Approved. ❑Denied.
(Circle one.) Comments:
.J r•elite4k
BUILDING
PLANNING &ZONING Reviewed by: � Date:3/13-1 k
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
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233
Office (904) 247-5826 Fax (904)247-5845 1(p- DECK-JC 8U
Job Address: ..2.49 Am, Sr. Permit Number:
Legal Description /_o7 5 4</,28 rsEcrtoil n7ea o SA, iC &AGN Parcel #
Valuation of Work$ /500 ProposedWork heated/cooled t' t
F non-heated/cooled
Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial Residential
If an existing structure,is a fire sprinkler system installed? (Circle one): es o N/A
Florida Product Approval #
For multiple products use product approva ori
Describe in detail the type of work to be performed: 32' l e ja 11,11,1/416 iJ4(.1.. @ 5t JAL e
Property Owner Information:A
Name: A /I K&A / Valk'/Ef Address: b70 dCCtil.D
City ,/'Tt_4,/T!G efilai Statert.Zip 52153 Phone 901-- 9+5_ 2 S 0 0
E-Mail or Fax# (Optional)
Contractor Information: CONTRACTOR EMAIL ADDRESS:
Company Name: &t0f-JAr-fai �LU1.t3t)ICbeyes ),JE Qualifying Agent: --K)3621 LeVC-SQ 6(;
Address: 101 Lek./61 F..b City ATL,
Office Phone State Zip 5z-z-35
'-f 4,41- 13/3 Job Site/Contact Number 3-/-I- f-/zo Fax#
State Certification/Registration# 12,170 32053 241 -12,1 3
Architect Name&Phone#
Engineer's Name&Phone#
Fee Simple Title Holder Name and Address A,.S-p RE µ,OSCpl G F.-
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 I cert that no work or installation has commenced prior to the
issuance
work istnot commenced withinl be six performed6) nths,!o ortifconstrueet the actionrds or oak isll aws suspeg lating suspended or abandoned for aion in bis pe iod of sixn(6)mon hs at any time afnull
ter
work is commenced. I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells,Pools,Furnaces,Boilers,Heaters,
Tanks and Air Conditioners,etc.
I
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 herebycert fy that I have read and examined this a plication and know the same to be true and correct. All provisions of laws and ordinances governing this
type ofworkwill be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the
7rovisions of any other federal,state, or local law regulating construction or the performance of construction.
signature of Owner . Signature of Contractor
'rint Name ll h i h "R o h Ci'i e Fk. l'''''),"
Print Name eezr Lew-,Q1).6.
lefjO7
e e `/
lisDay o /�f�/ZL'�t ,20_11 Bes/O Day of
:.fir�..,
• GEORGE GARY ROBINSON , _
?'� "` t•i lel ; MY COMMISSION#FF079774
f taly P bl MY COMMISSION#1-1-0/yi/� ' �r 1,....„1..„. y �' er
'.s-cl7 Ota /Pu 11C ,' �d'{, EXPIRES uecember 29,2017
%, a�., EXPIRES December 29.2017 '' „".••
a n.•.
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(407)798.0153 FloridallotaryService.com (4017 398-0153 Florida 1.26.ervice.com
Revised 01.26.10
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THIS SURVEY WAS MADE FOR THE BENEEll
BOUNDARY SURVEY. VAN DUSEN & VAN DUSEN. LLC;
' G RESTRICTION LINE AS PER PLAT. PEOPLES FIRST COMMUNITY BANK. • •
BASED ON THE WESTERLY LINE OF • n - /Lf •
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:RTY SHOYN HEREON APPEARS TO LIE IN
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;URANCE RATE MAP- COMMUNITY—PANEL
?0075 00C1 D, REVISED APRIL 17. 1988v
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fly OF ATLANTIC BEACH, FLORIDA. _ r"
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1T THE SICZIATIOC AHD ME - FLORIDA 1.10. SURVEYOR and MAPPER No
SCAL CS' w Flo uCEH9EA FLORIDA UC. SURVEYING & MAPPING,BUS NESS No.
AFPEfZ •
3Y: — t�ATWREiIGHiANDSU /EYORS,T INC.RT1JANUARY '
)7-35_;___ i 1500 ROBERTS DRIVE, JACKSONVILLE BEACH, FLORIDA. 241 -8550 SHEET 1