295 Belvedere St bath & closet permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
RESIDENTIAL ADDITION - SINGLE OR TWO FAMILY RESIDENTIAL ADDITION
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: RESA17�0013
Description: 9'x3l'ADD[TION (OATH &CLOSET)
Estimated Value: 31000
Issue Datei 8/21/2017
Expiration Date: 2/17/2018
PROPERTY ADDRESS:
Address; 295 BELVEDERE ST
RE Number: 170501 0000
PROPERTY OWNER:
Name: HEZEL STEPHANIE A
Address: 295 BELVEDERE ST
ATLANTIC BEACH, FIL 32233
GENERAL CONTRACTOR INFORMA17ON:
Name:
Address:
Phone:
Name: REMODELING PROS
Address: 2763 N MANDARIN MEADOWS DR
JACKSONVILLE, FL 32223
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work,a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
NOTICE OF COMMENCEMENT
State of—Florida— County of—Duval—Tax Folio No. 1340615.0000(2016)
To Whom It Mav Concern:
The undersigned hereby informs you that improvements will be made to certain real property.and in accordance with Section 713 of
the Florida Standee,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: Lot 454 and the North i/i of Lot 455,Saltair Section No 1,according to the map or
plat thereof,as recorded in Plat Book 10,Page(s)8,of the Public Records of Duval County,Florida,RE#17050 1-0000
Address of property being improved: 295 Belvedene SE Atlantic Reach,FL 32233
General description of improvements: Addition to the South for 2�ful I bath and 2 walk in closets,removal of wall in kitchen,
move electrical circuit breaker panel,add small closer in TV room.
Owner:Stephante 11=1 Address: PO Box 330163,Atlantic Beach,FL 32233
Owner's interest in site of the improvement:_100%
Fee Simple Titleholder(if other than meter):
Name
Contractor:Keith Sheets,Remodeling Pros,FL Contractors License CBC 1252347
Address: 2763 Mandarin Meadows Drive North,Jacksonville,Fl,32223
Telephone No.: 904-5454639 Fax No
Surety(if arry, 0/4
Address- Amount of Bond$
Telephone No: FuNo;
Name end address of any person making a]oan for the construction of the improvements
Name-—Darrell Prather
Address: 3439 Washburn Rd,Jacksonville,Fl,32250
Phone No: 904-710-0397 Fax No:
Name of person within the Start of Florida,other than himself,designated by owner upon whom notices or other docaments may be
served: Name:—Durrell Prather
Address: 3439 Washburn Rd,Jacksonville,FL 32250
Telephone No: 904-710-0397 Fax No:
In addition to himself, owner designates the following Peramn to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Stattes. (Fill in at Owner's option)
Name:—Dartell Prather
Address: 3439 Washburn Rd,Jacknnville,FL 32250
Telephone No: 904-710-0397 F.No:
Expiration date of Notice of Commencement(the expiration date is one(1)year from the data of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLV OWN
'd.!!�
Date: ghs/1-7
Before me Un� il�4, dy.f I.the County of Duval,Sta,
01 fl0oft hee perecredlY appeared ,a e A ff�
ronaxany Known: or
Ow#20I7IM30,OR8K18094 PageJ75, Produced ltt�ffimt
Number Pages:I
RaCaxded0a(18/2017at1I:24AM, ..- c—ornissione.pires:
Romme Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
RECORDING$10 00
MY=65IO1NtFMF9R801169
EXPIRES J..03,2020
AmbCity of Atlantic Beach APPLICATION NUMBER
ill Building Department (To be assigned by the Building Department.)
8GO Seminole Road
ITTAtlantic Beach, Florida 32233-5445 R F-SR 1-7 - DO 15
Phone(904)247-5826 Fax(904)247-5845
E-mail: building-dept@wab.us Date routed:
Cityweb-site: httipA�.coalb.us 2LL�, -
APPLICATION REVIEW AND TRACKING FORM
Property Address: 29 �5 RFL_VF__IZ) 7 Dmartmentreview required Yes No
(`Suildin)�
Applicant: R&-Ac)b LAP'�'Q P(.?-O S. -PTa-nning &Zomnr,,
Tree AdminisfraTor
Project: -F`-U5r1C_W0-FRt>
-165ofic Utilit=s5
Public Safety
Film Services
Review fee $ Dept Signature
Review or Recei it
Other Agency Review or Permit Required of PenmItVerIfIedPBy Date
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
ST.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
_DMvision of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: E]Appmved. enied. E]Not applicable
(Circle one.) Comments:
CLBUILDIN 2
ONINC Reviewed by: r7l�)4 Date:-2
TREEADMIN. Second Review: E]Approved as revised. Oenied. ONot applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:_E-_�—. 1
FIRE SERVICES Third Review: proved as revised. E]De V
xP med. Ohlot applicable
Comments:
Reviewed by:—/-'n Date:_kJ6'/')
Revised OWID12017
V101 CITY OF ATLANTIC BEACH
800 Seminole Road
OFFICE COPY Atlantic Beach, Florida 32233
Telephone(904)247-5800
PAX(904)247-5845
REVISION REQVEST SHEET OR
CORRECTIONS TO "EVIEW COMMENT
Date: ;7 Received by: Resubmitted: -
Permit Number: V-E-GA rl-OCA-S
Original Plans Examiner: Project Name:
Project Address;.2�- ardA� P- 159—�
Contractor, eora [,,-.< RC&-4L;r ContactName: "Lel
Contact Phone
Contacte-mail:
Revision/Plan Due: $ SV,CL,)
Description of Proposed Revision to Existine Permit:
Additional Increase in Building Value: $ Additional S.F.
Site Plan Revised: Public W U Approval:
By signing below.I(promormanc) affinn that the above revision
is inclusive of the proposed changes.
46!:� 9-/-11�7
S1gnimq§XContmat`mr/Agent(Contractor must sip if incteace in valuation) Date
Office Use Only
one Appucvcal: ReJcMd: x NIA to E"i
Plan Re�iew Comments
�s , '-� III Ce 4 e,�l 1- 10-C I?qe 4- o^
Department revim required Yes No
�#I,!Rn�28Zonlna>
Tree Administrator Plans Examiner
Public Works
Public Utilities
Public Safety Date cmasMM17 R-4
Fire Services
CITY OF ATLANTIC BEACH
800 Seminole Road
OFFICE COPY Atlantic Beach,Florida 32233
c� f) Telephone(904)247-5800
FAX(904)247-5845
ding,
REVISION REQUEST SHEET OR
CORRECTIONS TO REVIEW COMMENT
Date: Received by: Resubmitted:
Permit urn Fen C)
Original Plan RC � R I:Z=CL t Name:
Project Arldn
Contractor:/ Act Name:
ContructPhone : S'V VA 3 r Contact e-mail: 00,41_81L;eO� 4_ nZ, C C>,"l
Revision /P ) Due: $ 5'0.0o
Descri tion of Proposed Revision to Existing Permit:
AUG
Additional Incireme in Building V ue: $ Additional S.F.
Site Plan Revised: lqz Public W U Approval:
By signing below.I(print canne) 1;?,ef
affinin that the above revision
is inclusive of the proposed changes.
99�atuVof Contractor f Agent(Cdduacto�antat�ian if inennece in valuation) Date
office Use Only
Rejected,
D.: 0 Appooved: NIA to Dept
Plan Review Comments:
DRpartment review naguired Yes No
'REW-alt&Zoning
Tree Administrator Plans Examiner
Public Works
Public Utilities -16-r-)
Public Safety Date C.W M"R
Fire Services
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
OFFICE COPY ("4)247-5800
—061—
BUILDING DEPARTMENT REVIEW COMMENTS
OFFICE COPY
Date: 7.18.2017
Petr m it 1' RESA17-0013 Site Address: 2763 Mandarin Meadows Dr.
Si ,Address: 295 Belvedere St.,A.B. W.,JAX
Review: 1 Phone: 904.545.4638
RE#: 170501-0000 Email: bksQoal.com
Homeowner: Stephanie A Hezel,
Applicant: Remodeling Pros Stephanie.huel@gmail.com
C0RIWCTI1l '�I t 11� rils � II ih� se comments are from I �1 1:: s that are
rev i as appli,21! 0 s that are
Submit 2 copies of the Florida Product Approval Information Sheets for a
components and cladding on this addition. Numbers shall not have R values.
Whole numbers and decimals where needed.
2. None of the Structural plans submitted from Paul S. LI, P.E.,:has his raised
seal or stamp. That includes the 2 sets of 10 page plans and 2 sets of
structural load calculations. His signature is on the documents but th
require his seal or stamp.
Mike Jones
Building lnspector/Plax� Reviewer
City Of Atlantic Beach
800 Seminole Road
Atlantic Beach, F�X2233-5445
Ofc (904) 247-5844
Fax(904) 247-5845
6f1h ,7deol Rev;ftv Comy".-^41 -7,1 J`,1 7 k'yl
1
6�d 0
—kD 6e— -713C 17
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
OFFICE COPY ATLANTIC BEACH,FL 32233
(904)247-5800
BUILDING DEPARTMMEEN REVIEW COMMENTS
Date: 7.18.2017
Eermi - I RESA17-0013 Site Address: 2763 Mandarin Meadows Dr.
'#*
Site Addrem: 295 Belvedere St.,A.B. W.,JAX
Phone: 904.545.4638
RE#: 170501-0000 Email: bks(a),aoLcom
------ Remodeling Pros Homeowner: Stephanie A Bezel,
Applicant. Stephanic.hezel*gimaiLcom
CORRECTION COMMENTS: These comments are from I of 4 departments that are
reviewing this application.
1. Submit 2 copies of the Florida Product Approval Information Sheets for all
components and cladding on this addition. Numbers shall not have R values.
Whole numbers and decimals where needed.
2. None of the Structural plans submitted from Paul S. LL P.E., has his raised
seal or stamp. That includes the 2 sets of 10 page plans and 2 sets of
structural load calculations. His signature is on the documents but they
require his seal or stamp.
Mike Jones
Building Inspector/Plan Reviewer
City Of Atlantic Beach
800 Seminole Road
Atlantic Beach, FL 32233-5445
Ofc (904) 247-5844
Fax (904) 247-5845
c) r,dRew 'ie �,, CO3-Inly� e--v4ff
8.70MI7
1. According to the floor plans submitted, there are no bathrooms entry doors that
are ADA compliant for wheel chair entry. The addition has accessibility into the
master suite, but no into the water closet area or the shower entr6c. The 2014 51h
I
I
Edition of the Existing Building Code-Residential, says that accessibility
provisions for new construction shall apply to additions. Section 1105.1
MINIMUM REQUIREMENTS.Please resubmit page 2 of floor plan to show
corrections to the entry of the water closet and shower entry.2 copies signed and
scaled.
Ed n the E in d d R d a
en I' says that �c
g Buil 'ng Co e- es t a
a t'on shall pp'y to additions. Seeno
U P Ica e es b i age 2 floor p ibilit'
ess
'05�1
Ian 0 show
ry e e ry copies signed and
S-p r u m tp of
p r iti of xit ,true I water clos t and shower nt .2
ov1sio a for new c as
NIMU� t QUI MENT
orre -on t he e' of the
sealed.
2. Also from the same existing building ode choose a method of construction
ti ' I v a a
compliance and alterai a e el nd bmit that inforrmation on the cover page,
cop
page 1,signed and seal d 2
Mike Jones
Building Inspector/Plan Reviewer OFFICE COPY
City Of Atlantic Beach
800 Seminole Road
Atlantic Beach, FL 32233-5445
Ofc (904) 247-5844
Fax (904) 247-5845
Second Review
2
Building Permit Application OFFICE COPY
City of Atlantic Beach
800 Seminole Road,Atlantic Beach,FIL 32233
Phone:(904)247-5826 Faut:(904)247-5945
733
Job Address: 2 15 515L I/CbtiC AXMX 60" FLArmit Number: & 6 SAJ
��- o 0
Legal Description 5k7t9w SfLilop I tcrr v/ RE# 17o5L51 -000D
Valuation of Work(Replacement Cost)$ :%0190 Henshild/Cooled SF.P�?O Non-Heated/Cookof
• Class of Work(Circle one): New 4ii;; Alteration Repair Move Demo Pool Window/Door
Residential
• Use of existingliproposed structure(s)(Circle one): Commercial EEiR
• ff an existing structure,is a fire sprinkler system installed?(Circle one): Yes ljj� N/A
• Submit a Tr.Removal Permit Application IT any treas are to be removed or Affidavit of No Tree Removal
Describe In detall the type of work to be performed:
Awl
rev �Pmr�yo,t SA'."H§ '7
Florida Product Approval# YX/'j VIA ldw#� for multiple products use pmduct approval form
Propertir Owner Infewmation -3 ly/V.16
Name: _'�TEP"kxc 6. FVC-ba- Address ?'V� be-VEDC-2tC '�`T
city Stste�L- Zlp-32?-3 �) Phone 90'f-37T- 7-1
E-Man�MnMhe�3�m CW!A(n"l . C-0�
Owner or Agent(if Agent,Power of AftoriVey or Agency Letter Required)
Contractor Infoinnation
Name of Company: ai�ylngftem:
Address �4�eg�' zip
Office Phone 2'6' pact Number I
State Certification/Registortion#(/X� 3Y:z E-114,11-4 R 5: �93 qp/'Z ;;�e`
Architect Name&Phone#
Engineer*s Nanne&Phone# �,L L,* 7 7 L - 6
Workers Compensation_ CZCJ'i�-
E,erapt/r.../e..broplayees/apiredanDoe
Application is hereby made to obtain a permit to do the work and installations as Indicated.I certify that no work or installation has
commenced poor to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulationg
construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc.
OWNEWS AFFIDAVIT.I certify the all the foregoing information is accurate and that all work will be don a i n compliance with all
applicable law regulating construction and zoning.
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
UR NOTICE OF COMMENCEMENT.
(signature of Owner or Agent including (signature Contracti
Signed and sworn to(or affirmed)before me this day of Signed Ind sworn to(or affirm, bef -t SLZ-Iay
-10 C Z�3)-7 .bv c, �p f
by
�-j
(1 61111 ari
L
i MY COMMISSION N FF981 169
EXPIRES Xro 03,MM
11"nW'KnoW.M I PersonallyKnown OR
[�Oocduced Idearfi.tion I Produced dentificatlari
Type of Idotificati.r: Type of identification: S 3ZO-5oz 0--3
M
OFFICE COPY FORMS
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FORM R402-2014
Residential tJulldlng Thermal Envelope Approach
Scope:COMP11811,00,11th Sdon R402.1.1 Orin FZ�aa -a'',..... Climate zone[3
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on Table R402A and all applicable mandew Cable.To comply,a u; I I ng Sidentlal buildings.abortions.renovations
in all of the energy efficiency Equjr,,,�,
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FORMS OFFICE COPY
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DESIGN & CONSULTING ENGINEER OFFICE COPY
8160 Baymeadows Way West, Suite 145
JACKSONVnLF,FL 32256
Pb/Fax: (904)73.7-687&737-2385 Proiect#
'r, T��'
eITY OF NEPTUNE BEACH BUILDING DEPARTMENT
WIND LOAD
BASED ON THE FLORIDA BUILDING CODE 2014 RESIDENTIAL,
FIG. R301.2(4), TIES SITE IS IN THE (f-0 APH ZONE. PER ASCE 7-10,
METHOD 1, THE IMPORTANCE FACTOR IS THE RISK
CATEGORY IS II, AND THE EXPOSURE CATEGORY FOR AN
ENCLOSED BUIL]DING.
ROOF ANGLE A tan -1
4-
MEAN ROOF HT 2 5�
HEIGHT & EXPOSURE ADJUSTMENT COEFFICIENT
Ww = 1 , C-� I/ ! - D '/ -�0 -4 -3 6 �2-
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City of Atlantic Beach APPLICATION NUMBER
Building Uepartment (To be assigned by the Building Department.)
800 Seminole Road
Atlantic Beach,Florida 32233-5445 EtSB 1-7 - 00 13
Phone(904)247-5826- Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
City welb-site: http:/&�.coalb.us _2La—A�==]
APPLICATION REVIEW AND TRACKING FORM
Property Address: 29�-D Q artnnentrevhsd� Yes No
Bu Idin
Applicant: Rr-_1Y\QbF_LtA3!Q� 1?(R-0 nning &Zonm
T eAdminismor
Project: FA ,:�)orrtot,3 -s u Ic or
ublic Utilities
Public Safety
Fire Services
Review fee Dept Signature
Review or Receipt Date
Other Agency Review or Permit Required 7M
mmt of Permit Verified
Florida Dept.of Environmental Protection
7 d
Florida Dept.of Transportation
of
'a enagament District
st.._ t
1) 0
St.Johns River Water Management District
Amy Corps of EnAeers
Division of Hotels and Restaurants
Division of Alcoholic Beverage-am T�---
bOther I I
APPLICATION STATUS
FReviewing Department First Review: E]Approved. ODenled. oNot applicable
(Circle one.) Comments:avie,,4Ay
BUILDING
PLANNING&ZONING Reviewed Date? 101
sc
TREEADMIN. Second Review: ErApproved as revised []Denied. F]Not appicalbie
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed bo��� Date?- 2 t-/ -)
FIRE SERVICES Third Review: ElApproved as revised []Denied, [:]Not applicable
Comments:
Reviewed by: Date*—
ROVI"d Ordig/2017
CITY OF ATLANTIC BEACH
800 Seminole Road
Atlantic Beach,Florida 32233
Telephone(904)247-5800
FAX(904)247-5845
REVISION REQUEST SHEET OR
CORRECTIONS TO REVIEW COMMENT
Date: Received by: Resubmitted:
Original Plans Examiner: ProjectName: WC20( Aay,�Pst
Project Address;
Contractor: Xf/10,X Contact Name,
ContactPh6ne : Contact e-mail: 6 kS_ 10WLC49-"1
Revision/Plan Check/Permit Fee(s)Due: $
Description of Proposed Revision to Existing Permit:
C_ 4A70 S'CJU266d�f 4 V S-1 -2
Additional Increase in Building Value: $ --cr Additional S.F.
Site Plan Revised: 4e,� Public W U Approval:
By signing below. I(print nme) ke tf� 674--',-7!5 affm that the above revision
is inclus�vdof!�xrproposed changes.
Signatme4fCon, acor Agent(Coresdor mw sip if inr,rsse n i valuation) Date
offi.I Js.Orly
D.� Appr�sd:_ Reted�- Notifiedby:
Plan Review Comments:
Department review required Yes No
�11 in
a dn—gg &zoni—ng">
n in Plans Exantiner
Tree Administrator
Public Works
Public Utilities
Public Safety Date VIN16 3
Fire Sewices F
City of Atlantic Beach
Building Department
800 Seminole Road
Atlantic Beach, Florida 32233_5445
Phone(904)247-5826- Fax(904)247-5845
E-mail: building-dept@coalous
QtYv,eb-sfte: http:/Avv�.coaleus
APPLICATION REVIEW AND TRACKING FORM
Property Address: 2_9�5 E_��.y De artmentrevieWre TulredYes No
Buildin
Applicant: RU-_'Y\C)beLtN_�� P(�,O �_ anning&Zonm
Tree Admims ra or
Project: o P-) u ic or
ublic Utilities
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified B Date
Florida Dept.of Environmental Protection
Florida Dept of Transportation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other
APPLICATION STATUS
Reviewing Department First Review; [gApproved. [-]Denied. E]Not applicable
(Circle one.) Comments: AP11
BUILDING
PLANNING &ZONING
ew A r a
De ONot applicable
Rev'evved b Date
y
TREE ADMIN. Second Review: [0:]Approved as revised. []Denied. [:]Not applicable
0
PUBLICWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:--,— Date:
FIRE SERVICES Third Review: ElApproved as revised, []Denied. []Not applicable
Comments:
Reviewed by: Date*
Revised 06/1912017
City of Atlantic Beach APPLICATION NUMBER
,JBuilding Department -1
800 Seminole Road Cro be assigned by the Building Department.)
Atlantic Beach, Florida 32233-5445 R esg 1-7 - Do l 5
Phone(904)247-5826- I'm(904) 247 5845
911 E-mail: building-dept@wab.us Date==muted: ]
Cityweb-site: http:1Aww.coab.us _iLLL�Z==
APPLICATION REVIEW AND -TRACKING FORM
Property Address: Department rOVIeW required yea No
B I in
Applicant: el`p�os anning &Zomn �,
,or
ree Administrator
Project: 'x U ic 0
ublic Utilities
Public Safety
Fire Services
Review fee Dept signature
0 ED
ther Agency Review or Permit Required Review or Receipt
ffhs
Florida Dept.of Environmental Protection Of Permit Verified By Date
Florida Dept.of Transportation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
10ther i_
APPLICATION ITATUS—]Denied, affcdapplicable
Reviewing Department First Review: ElApproved.
(Circle one.) Comments:
7 -
BUILDING
FPLANNING&ZONING
Date,
TREEADMIN. Second Revi—ew: E]Approved as revised. []Denied. E]Not applicable
P WORK Com ents:
fic-UTILITIES
PUB71;/V-t7
SAFETY Reviewed by: Date
FIRE SERVICES Third Review: [:]Approved as revised. []Denied. F]NOt applicable
Comments:
Reviewed by: Date,—
Revised OV1912017
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CITY OF ATLANTIC BEACH
800 Seminole Road
N Atlantic Beach,Florida 32233
Telephone(904)247-5800
REVISION REQUEST SHEET OR FAX(904)247-5845
CORRECTIONS TO REVIEW COMMENT
Date: Received by:_ Resubmitted:
Pennit Number: — 1 -
Original Plans Examiner: Project Name:
Project Address�.�-V 0121100k�P -<�O—
Contractor: &Pi( R(446r ontactNanie: J12z?q t"-J-r
Contact Phone :e
V/!�"?
K Contacte-mail:
Revision/Plan Due: $_,MOD
Description of Proposed Revision to Existing Permit:
Additional Increase in Building Value: $ Additional S.F.
Site Plan Revised: ublic W U Approval:
By signing below. I(print c)_ affirrin that the above revision
is inclusive of the proposed changes.
46!:� 9�-/—11;7
Signit*,of Contracitor/Agent(�ntnnntor nnnst sip if inciesse in valuation) Date
Office Use Only
D.tc Approwd: Rpinect N/A in Dert
Plan Review Comments:
Department review required Yes No
f ld],j�. ZZ-1- 144�
1pn ..g a zo�� Plans Examiner
Tree Administrator
Public Works
Public Utilities d�
Public Safety Date CrenWM3111 ew 4
Fire Services