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303 ATLANTIC BLVD - REVISION 12/21/17 F-v. • r\J')jJCITY OF ATLANTIC BEACH ti 800 Seminole Road 15 =, Atlantic Beach,Florida 32233 REVISION REQUEST/CORRECTIONS TO PLAN REVIEW COMMENTS Date _ Revision to Issued Permit Corrections to Comments Permit# fl os,t,p ,32)o Project Address 50 )V1 C--- 15LVD3 22-- ‘7-D Contractor/Contact Name \it_, C WC O OcI©K1 M3, /S<A0 ( r�QT�rr u Phone bL X 35 oZ Email �� C a� �.3 i Description of Proposed Revision/Corrections: Perm4 Fee Due $ �#2_ I �,..,P , AT-k-( Ctkil, *-- Additional Increase in Building Value $ 0 Additional S.F. i By signi g below,I , &z it,w,_ ( [tk 'eft _ affirm the Revision is inclusive of the proposed changes. (iNed name) 14Z) Signature of.ontrac or/Agent(Contractor must sign if increase in valuation) Date In (Office Use Only) Approved / Denied Not Applicable to Department Revision/Plan Review Comments Department Review Required: / Buil.:,: darrJ • . Reviewed By ree Administrator Public Works 01 --02 — le Public Utilities Public Safety Date Fire Services 41-A1p, TREE & VEGETATION AFFIDAVIT 41 City of Atlantic Beach ' ." -); Department of Community Development Planning&Zoning Division 800 Seminole Road Atlantic Beach,FL 32233 ��J;319' (P) 904 247-5800 (F)904 247-5845 PERMIT# , -C, MD'32.1 O SECTION I-APPLICANT INFORMATION Owner(s) r Legal Authorized Agent* NAME OF APPLICANT Al Mansur NAME OF COMPANY Al's Pizza Inc. ADDRESS OF COMPANY 303 Atlantic Boulevard PHONE (904)241-9194 CELL (904)537-6969 EMAIL al@alspizza.com CONTRACTOR CERTIFICATION NUMBER CGC 060512 ATLBCH BUSINESS TAX RECEIPT NUMBER SECTION II-SITE INFORMATION STREET ADDRESS OF PROPERTY 303 Atlantic Boulevard,Atlantic Beach,FL 32233 If an address has not been assigned to this property,contact the AB Building Department at(904)247-5826 to request an address. LEGAL DESCRIPTION OFFICIAL RECORDS BOOK 661 0,PAGE 1725 LOT 2,4 and 6 BLOCK One SUBDIVISION Atlantic Beach REAL ESTATE NUMBER 169729-0000 LOT OR PARCEL SIZE: APPROX 150 x 125 SQ FT 6,100 AC RESIDENTIAL COMMERCIAL x OTHER(SPECIFY) I affirm that I have reviewed the provisions of Chapter 23, "Protection of Trees and Native Vegetation"of the Municipal Code of Ordinances for the City of Atlantic Beach, FL and/or I have participated in a pre-application meeting with the Administrator of those regulations. Subsequently,I affirm that no regulated trees and no regulated vegetation will be damaged,destroyed and/or removed from the above-described or jacent properties in conjunction with this project. SIG ATURE OF OWNER SIGNATURE OF OWNER Signed and sworn before me on thisat0 day oft r1/4.04mticit„ , a p -j,by State of fl dM lark M Ct-n3U r'` County of V ell Identification verified:'LIQ€O neAlq \�h u w n Q Oath sworn: r Yes r No ELAINE M.SILVER &w J �� , MY COMMISSION#GG 072501 Notary Signature 'I` e.ge ite Bon*tM,NoeryPublic t!<,ilaw,;brs REV-TVA-v10.12 My Commission expires: a\‘3 POa_\