77 SHELL ST - DENIED REVISION FOR ENGINEERING CITY OF ATLANTIC BEACH
t 800 Seminole Road
4i;
Atlantic Beach,Florida 32233
Telephone(904)247-5800
+ I---7T-I'
T FAX(904)247-5845
r REVISION REQUEST SHEET OR
CORRECTIONS TO REVIEW COMMENT
Date:eat12ta1 2' (L Received by: Resubmitted:
Permit Number: /G- 2i Art 2 3 ocl
Original Plans Examiner: Mike t7Gtile.1 Project Name:
Project Address: ----;7 Site $l S'fneef
Contractor: TOM Si/UN. Contact Name: /41!( rn (./61/1..A et-
Contact Phone : q01 s Y S-2 5g? Contact e-mail: cf I )Gin S c%I a&E. e 5✓rriAi I. e owl
Revision/Plan Check/Permit Fee(s)Duc: $ 5T2.OCA
Description of Proposed Revision to Existing Permit:
DOon, i
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1
•1 1S.F OV - 8 2016
' nal Increase in Building Value: $ Additip 13
Additional
Site Plan Revised: Public W/U Approval: �
By signing below. I (print name) M- /)l iaei 61a1h1 . -l2, affirm thafili Ab t vision--
is inclusive of the proposed changes.
rn el/4- ie./.11/) -( Al-) tevid8/ 20 op
Signature of Contractat/Agent Contractor must sign if increase in valuation) Date
Office Use Only
Date: /i` 8-^l Rejected: Notified by Approved: J
Plan Review Comments: 1 l/ / / /
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Denartment review required Yieytio
Building
oning Plans Examiner
Tree Administrator
Public Works / /— R-/-6 _.___---_--- ------
Public Utilities
Public Safety Date Created 4/13/I6 Rev.3
Fire Services
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77 SHLL EEACH) L , �2Z
PAUL S. LI, P.E. #18305
8160 BAYMEADOWS WAY WEST, STE 145
JACKSONVILLE, FL 32256
E-Maly PaulLiEngebellsouth,net
Ph/Fax: (904) 737-6876/737-2385
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it.\li,,, City of Atlantic Beach . f--, � APPLICATION NUMBER
> , Building Department(---- (To be assigned by the Building Department.)
r --. .:- 800 Seminole Road
\ -'44 -."/=� Atlantic Beach, Florida 32233-5445 OCT 1 9 2016 1 O—SFR--a 3 1
\�::,,,_________y Phone(904)247-5826 • Fax(904) 247-5845
Lu;;i>r E-mail: building-dept@coab.us Date routed: 1Oli.e(1 I e
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 3C31 15 S he.41L-t. i)( D ent review required Yes No
Building
Applicant: New mActivkic eu:‘.t.cuis Zanning&Zonin
Tree Administrator
Project: ( LL.) S1 Vt.- t lkk 1/1.00,‘Q ublic Works
Public Utilities
Public Safety
Fire Services
Review fee $ co Dept Signature 7' t
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. I 'Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by: 24'''' ii: 1 Date: /�� �6
TREE ADMIN. Second Review: A roved as revised.
❑ pp ['Denied.
• WORKS Comme ts:
A
PUBLIC UTILITIE
P -/91--//c2
IC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ❑Denied.
Comments:
•
Reviewed by: Date:
Revised 05/14/09