102B Ocean Gate - Well Review 5°.:Lv, City of Atlantic Beach APPLICATION NUMBER
�' D�r Building Department (To be assigned by the Building Department.)
800 Seminole Road
Y �� Atlantic Beach, Florida 32233-5445 I '4 24 2Qjr
Phone(g04)247-5826 Fax(904) 247-5345
y�loA E-mail: building-dept@coab.us Date routed: a—a3a0(7
Cityweb-site: http://vewv.coab.us
APPLICATION REVIEW AND TRACKING FORM
n(',
Property Address: IOZ' OC3» a 1�Dr 1 ad ga.)) De artment review required Yes No
Building
Applicant: f0(' NCLyrCni'tl( Planning&Zoning
Tree Administrator
Project: � � A.d',n p�c�l2,�( r�tuSt-.ku#{„rye` u lic
is Utilih
PuITc—S76ty
Fire Services
;Review fee $ Dept Signature. f�
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
rasion of Alcoholic Beverages and Tobacco
Other.
APPLICATION STATUS
Reviewing Department First Review: Approved. ODenied.
(Circle one.) Comments:
BUILDING ,/V�_
PLANNING&ZONING Reviewed by: V UDate:Z
TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied.
tUBLIC
W RKS Com nts:
T ITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 08/14/08
City of Atlantic Beach APPLICATION NUMBER
ju 9 Building Department (To be assigned by the Building Department.)
800 Seminole Road ll- F,DV)–j3Z5
Atlantic Beach, Florida 322335445
Phone(904)247-5826 Fax(904)247-5845Date routed: aZOt1
F ori pI' E-mail: building-dept@mab.us
Cityweb-site: http:/Avww.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: I Oag OcoafJ;n 1e.Or ( Rnd) De artment review re aired Yes No
Building
Applicant: � njd . - fir &Lvrr-'R Planning &Zoning
Tree Administrator
Project: , PAS f�r'1' _ liy �!1 c 'lust Sri,Lt{nr}� u tic W
��— Ic Utilib
CxQA �G ��r• PgMrc afety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified B
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: [i Approved. ❑Denied.
(Circle one.) Comments:
BUILDING Jed /7)'f'GG�il�i� 6.4'yek�-
PLANNING &ZONING Reviewed by: Date:
TREE ADMIN. Second Review: ❑Approved as revised. ❑De led.
PUBLIC WORK!D Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
}I-
=1 CITYOFAI-LANTICBEACH
AreasCONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
Boo c
u Z Atiamic Seder,Flood,32233-`445
PLEASE SUBMIT COMPLE904-247-5600
TE SETS OF PLANS WITH APPLICATION. Fax 904-247-5645
Data "Pt,- ZO
Job Addre55i( > (A(a�� e �7� �/ PERMIT# o
'rO ql"f N ISSUEDBYTHECITY 11
Permitee: 1 r � P•"t �'^.s 4+++ah,n. wiry
•fe».,i
Familial,Address: Telephone#_ A n y_ ;3 d L
Requesting Permission to Construct:
tL at ( ly
Location: (Reference to Cross-Street)
I Applicant declares that prior to filing this application he has ascertained the location of all existing utilities,both aerial and underground and the accurate locations are shown on the sketches.
A Letter of Notification was mailed to the following Udlities/Municipalities:
Jacksonville Electric Authority
Bell South Telephone Company
Ferrell Gas Is( ) No ( ) Date:
Comcast Yes ( ) No ( ) Date:
Yes( ) No ( ) Data:�--
2 Yes ( ) No ( ) Date:
Whenever necessary for the consWction, repair, improvement, maintenance,
alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public
Works, any or all of said poles, wires, safe and efficient operation,
hereunder, shall it immediately removed from said street or easement or reset or relocated hereon as
required by the Director of Public Works,end It the expense otheror facilities
the ermitteeaunless nrei reimbursement es
authorized.
3. All work shall meet City of Atlantic n ofBeach or Florida Department of Transportation Standards and be
Performed under the supervisioQ,l.�„f n ,
Superintendent)located at rt
4Telhone 9.
All materials and equipment shall be su — (Contractors Project
5. All c' to inspection by the Director of Publio Works or his designee.
dl'Property shall be restored to its original condition as far as practical, in keeping with city specifications i
jem-
and the manner satisfactory to the city,
S. A sketch of Plans covering details of this installation, as well as, a co
Part of this permit. Calculations showin an entre se In tm ervtous area on owner's lot be
the e
Richt of We v are to be Included with this ao I r py of a recent survey shall be made a
7. This penndtee shall commence actual construction in good faith with
more than 60 days from date of permit approval, then permittee must review the permit with the Director of
Public Works to make sure no changes have occurred in the area that would affect the Ipermitted f the lconstruction
s
B. It is understood and agreed that the lights and privileges herein set out are granted On to
City's fight, title and interest in the land to be entered upon and used b the
times, assume all risk of and indemnify, defend, and save harmless the City of Atlantic eachfrom tnt of all
against any and all loss, damage, and cost of expenses arising m any y annerthe l off the exerciseand the loe at 0M and
exe
9.
TheroDirectorises by the of Poblicder of the Works shall saidrights
gno eduiv
enty our (24) hours prior to starting work and again _
es
immedia ly upon completion.
OWNER
Signed: - a„la(I � / l
Before me Ihls Y day of Date:_
Stale Of Florida,hes Persona Jr .ared In the County of Duval, NMLE MURaAY
Nofary public at Large,State of Florida,county `� �' ..
My cummlasione ty MDuval. - NOUry PoMk-Bled Florida
zprres. Commission•FF 941841
Personally 4e, "s? p My Comm-Expires Apr 2.2020
Produced ldenflrioe,bir ?a F1
Banded lmouph Mardi Notary Ass, r