1858 Selva Grande Drive WORKS Sya,�fl� City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
r 800 Seminole Road p— J 6C O 1 11T_D04
IAtlantic Beach, Florida 32233-5445 {�
Phone(904)247-5826 • Fax(904)247-584 NOV 132017 n11 Date routed:
E-mail: building-dept@coab.us
City web-site: http://www.coab.us ::J
APPLICATION REVIEW AND TRACKING FORM
Property Address: l gS$ L-PC Department review required Yes No
Applicant: nin &Zoni
Tree Administrator
Project: �C (� W00A A&t_ 1-4- (a0P[(A0_ W rks
D &L Public Utilities
1�-- P"
Public Safety
Fire Services
Review fee $ Dept Signature
Other Agency Review or Permit Required Review or Receipt 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: WlApproved. ❑Denied. ❑Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed by:� Date:
TREE ADMIN. Second Review: []Approved as revised. ❑Denied. ❑Not 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 05119/2017