94 W 3rd St screened enclosure revision �j'�tdf�r CITY OF ATLANTIC BEACH
Jit 800 Seminole Road
j Atlantic Beach,Florida 32233
f) Telephone(904)247-5800
,.:�,-" '• - FAX(904)247-5845
�rmis)
REVISION REQUEST SHEET OR
CORRECTIONS TO REVIEW COMMENT
Date: 12/16/lG Received by: Resubmitted:
Permit Number: (a- SC21J -7-G43
Original Plans Examiner: Project Name: 5 r In n e s r)C r
Project Address: qy V✓. 3rd SFree+
Contractor: hnarr 1IaMP ZM�reyeMen+s Contact Name: ; l'
Contact Phone : (9041262-1Srr Contact e-mail: 6ch A nrr bell snu+ln. Ae+
Revision/Plan Check/Permit Fee(s)Due: $
Description of Proposed Revision to Existing Permit:
6',4-e nl o.n Mwrkea w;+" SP+backs
• Tree b Vtbe+o-+;on Aff'day A- /An +ree roma✓al oA fob &;+e )
Additional Increase in Building Value: $ Additional S.F.
Site Plan Revised: Public W/U Approval:
By signing below.I(pant n. C l7 s+ao ti er Rer n;n a affirm that the above revision
is inclusive of the proposed changes.
a_- /W, a, 12/15 /6
Signature of Contractor/Agent(Contactor must sign if increase in valuation) Date
Office Use Only
Date: Approved: Jl Rejected: Nctifiedby:
Plan Review Comments:
Department review required Yes No � e
Buildingy
Plannin oning
Tree Administrator Plans Examiner
Public Works
Public Utilities
Public Safely
Fire Services Date om�+a�one nr.s
TREE & VEGETATION AFFIDAVIT
City of Atlantic Beach
Department of Community Development
Planning&Zoning Division
800 Seminole Road Atlantic Beach,FL 32233
(P)904247-5800 (F)904247-5845 PERMIT#
SECTION I-APPLICANT INFORMATION r Owner(s) -gal Authorized Agent'
NAME OF APPLICANT LV)r*% 5�IGJn Schnerapr
NAMEOFCOMPANY $ehnnff EIoMe. S2nnrovP.MPni'
ADDRESS OF COMPANY ,q2a PhiII10$ IPof Kwo.4 Onve N. .JacksonvillefrL 3225!0
PHONE (q04)2Q-ISI 7 CELL EMAIL SGlsnnr(�ball5au3i..ne+
CONTRACTORCERfIFICATION NUMBER LRC (34102%
ATLBCH BUSINESSTA%RECEIPT NUMBER 78(,6 — Calrboudn( AL 772 ,309
SECTION 11-SITE INFORMATION
STREET ADDRESS OF PROPERTY qy W. 3rd Sireeit
rFm address hos norbeenassignedto thisproperry.CorNsatheAS Building Didartmeatm(M)247-5826 wrequesran address.
LEGAL DESCRIPTION I8-34 1-1-29-21F SPokor% H A+Iodir- Beach
LOT 5 BLOCK 90 SUBDIVISION 03119
REAL ESTATE NUMBER I70%32'00S0 LOT OR PARCEL SIZE: SQFT "IM, AC
RESIDENTIAL House COMMERCIAL OTHER(SPECIFY)
1 affirm that 1 have reviewed the provisions of Chapter 23, 'Protection of Trees and Native Vegetation"of the Municipal Code of
Ordinances for th iry of Atlantic Beach,FJ.and/or I have participated in a pre-application meeting with the Administrator of those
Zed 5 e uentk I affirm tl to regulated trees a regulated vegetation will be damaged,destroyed and/or removed
from thea nbedoradja tt rdperties inc 'c ctitri on with thispmjea.
7.
IGNA URE 0 SIGNATURE OF OWNER
Signed and sworn be remeonthislrJ'i"'dayof („ Ila ,by State of FLA'
County of oLLVAt-
Identificationverfied: pR� ,g CtCEtJSE
Oath swom: r Yes r No
JoWh R 6eA-M ,'rn9
Notary Signature
REV-WA-v 10.12 My Commission expires: g✓'�",!'4e, JOSEPH R BERING
EXPIRES �7.
"W11"•BggN Thu Bu6yMNdary SrAvs
MAP SHOWING SURVEY OF
LOT 5, BLOCK 80, SECTION "H" ATLANTIC BEACH AS RECORDED IN PLAT BOOK
18, PAGE 34 OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
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