87 W 4th St JEA ROW permit rsi_uJ City of Atlantic Beach APPLICATION NUMBER
�' i Building Department (To be assigned by the Building Department.)
J W. 800 Seminole Road /�
u -x Atlantic Beach, Florida 32233-5445 Q�}l V O
`. �J Phone (904) 247-5826 • Fax(904) 247-5845 QQ I
`L� ��% E-mail: building-dept@coab.us Date routed: v f ZS( 17
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
' cru E 1 0
Property Address: 8�7 4 '—��� , as 3 epartment review reqd Y Yes
uilding
Applicant: -A - `fanning &Zonin
r., r
` t Tree Administrator
Project: C.: � ``', Q � 'ublic Wor
• • 'ublic-Ofilitigs
Public Safety
Fire Services
Review fee $ Dept Signature
F Review or Receipt
Other Agency Review or Permit Required 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: roved.
p ❑Denied. of applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING _ DIC(
�(
Reviewed by: Date: '
vi
TREE ADMIN. Second Review: Approved as revised. Denied.
❑ i INot applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ['Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017