533 Seaspray Ave tree affidavit for metal bldg permit I
g � CITY OF ATLANTIC BEACH
800 Seminole Road
Atlantic Beach.Florida 32233
r Telephone(904)24?-5800
FAX(904)24;-5945
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REVISION REQUEST SHEET
Date: —17 Received by: Resubmitted:
Permit Number:
Original Plans Examiner:��-2X�e_y.;,m Project Name:_
Project Address: ,x-3.3 S ` _A-v'w -
Contractor.0*aolras j;j _ _ contact
Contact Phone : 7 Conan, e-mail: ae/1cC (� le�C Lb(
= Revision/Plan Check/Permit Fe (s)Due: S
Description of Pr000sed Revisio a to 6xi tine_Permit:
Additional Increase in Building Value:- $ Additional S.F.
Site Plan Revised: NG I ' Public W 1 U Approval:
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By signing below.I(prim ------ affirm that the above revision
_ is inclusive a proposed es.
Si lura of Conaactor I Agent(cmu.�ur nun span it -"s" Dere -t,,
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c.a: Z,110-4167 App�:_�__ OlI
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Plan ReviewCommeirM ''Pe
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Department review re uired—(Yes No /
Building
Planning BZonin
Tree Administrator Plans Exmnimr
Public Works i L
Public Utilities
PUWC i Fire Services - ( Deter:7�,.r.,
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r TREE & VEGETATION AFRO&NaT------ ---._
City Of Atlantic Beach
Department of community Development
Planning&Zoning Division
806 Seminole Road Atlantic Beach,FL 32233
(P)964247-5800 (F)904247-5845 'PERMIT#
SECTION I-APPLICANT INFORMATION (' Ovmedz) �" Legal Authorized Agent*
NAMFOFAPPDCANT _�L,1QYt,fcG �oK
NAME OF COMPANY 1 ' art.-t'ts :Q Ti;+
ADDRESSOFCOMPANY 131
PHONE Cp`70.42�LCELL 1 EMAIL
�` C� C.Ct . Ior Z.
CONTRACTOR CER'DFKATION NUMBER _Cd6L 1;'546a �
ATLBCH BUSINESSTAX RECEIPT NUMBER
SECTION H-SITE INFORMATION j
STREEFADDRESS OF PROPERTY 7�Z2 !.I aSM.a Ay f
rlanodd,ebaosn bem auynedroltisPmperry,mnioad.ABauadegaeponmmtat l9a:1 N7,S8M torpwstanaddiesv
LEGAL DESCRIPTIONS-!rY �7?S .,2fa
44d . Scws(aaa.I 7570
1 �
LOT 4120 BLOCK pZ SUBDIVISION
PEAL ESTATE NUMBER ZQ} j�0.� LOTOR PARCEL SIZE: �-x !pU SFT �(�9O AC
RESIDENTIAL f COMMERCIAL OTHER(SPECIFY)
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1 amrm that I have reviewed the provisions of Chopttr 23 Tmtectum of Trees and Native Vegetation"of the Munidpol Code of
Ordinances for the Ory ofAr/anuc Seach a and/or I hove participated in a pre-appikodon meeting with the Administrator of Mos,
regulations. Subsequently,I atttrm that no angulated pees and no regulated vegetation wiAbe damaged,cintroyedanaVor removed
from the above-descdbed ar adjacent pmperrles In conjunction with thispmj,ct.
I
SIGNATURE OF OWNER j SIGNATUREO DOWNER
Signed and sworn before me on tis day of ,by Stale of
County of
Identification verified:
Oath swarm. r:- Yes r- No
Notary Signa ture
REV-TVA.v10.12 i y Commission expires
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