390 Plaza RES18-0143 AAML CITY OF ATLANTIC BEACH
800 Seminole Road
IF Atlantic Beach,Florida 32233
/r REVISSION REQUEST/CORRECTIONS TO PLAN REVtE,W CCOMMENTTS-� (�
Date b . I b Revision to Issued Permit_ Corrections to Comments✓ Permit# KG.+!(� 1
Project Address 16.2w A
Contractor/Contact Name �� OSS` (� SSS Ccs-. F�u�Cb•t�
Phone q0q — 2"SK —G3oq Email Cmc
Description o//f��Proposed Revision///Corrections: Permit Fee Due$
/gtlf�t N 7 Yti. t c A (0 -,- esf
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Additional Increase in Building Value$ Additional S.F.
By signing below,I affirm the Revision is inclusive of the proposed changes.
(privted name)
Signature of Contractor/Agent(Contractor must sign if increase in valuation) Date
(Office Use Only)
Approved Denied Not Applicable to Department
Revision/Plan Review Comments ^�'�"� A" ✓� h �OP/ r Scan �o fir'%1-t 34.E
�1tC copy.
Department Review Required:
Ink
uildin_ g
g Toning Reviewed By
Tree Administrator
Public Works �1
Public Utilities
Public Safety Date
Fire Services
EXHIBIT A: LETTER OF AUTHORIZATION
City of Atlantic Beach
Community Development Department FORINTERMLOFFICEUSEO
800 Seminole Road Atlantic Beach,FL 32233 II
(P)904-247-5800 PERMIT# &3! 'Q�NL
OWNER INFORMATION1/����jp7�f/ OFFICE COPY
W
NAME -j L((j AAfd Y,r/OL PHONE# ^—
ADDRESS I 7'35tO pLX�l" CELL# 904. 3(2- 4142
CTIY , j-Lp,0n(, STATE r-1— ZIPCODE 32Z'3-3
AGENT INFORMA//TION++��
NAME "I AC.-V– 05nC/2 PHONE# p
ADDRESS I I I Z 3's, ��S-,eFT�I 1 CELL# '[04 (0
CRY N V"1 v4^�� �j vtrt- STATE F7 L_ ZIPCODE 322 4
)A oz— is hereby authorized to act on behalf of
ILA N N I WiE�0 o2— the owner(s)of those lands described
in the attached application and as described in the attached deed or other such proof of ownership as may be required
In applying to the City of Atlantic Beach,Florida,for an application related to a Tree and Vegetation Removal Permit.
I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IS CORREC
AAT.Signature of Property Owner(s)or Authorized Agent
� fAU ;-Xtjd wetel. I�' 1Ud- 26tB
SI NATURE OF WNEROR LEGAL REPRESENTATIVE P MORNPENAME DATE
SIGNATURE OF APPLICANT PRIM OR TYPE NAME DATE
0
Signed and sworn before me on this day 9f –3uNF `JOIo by State of
'3D (*�AI WF-515- L Countyof bu V
Identification verified: 'J�co
Oath Sworn:'�Oes ❑ No Fy,-X411>.2(T✓o
ALBERT RiNO gnature 11
Notary Public-sta IFIcrNa rri
Commis:ion N FF2 mmisslon expires b •09 v�019
fdY Comm.E"Ims Jun 9.2019 '
02TREEREMOVAL-EXHISITALetterofAu 0ritb Bd .O@rZRdffnrc��ri :-Conal P.,:ny^.