598 SEASPRAY AVE - FENCE � CITY OF ATLANTIC BEACH
• ' 800 SEMINOLE ROAD
yr
ATLANTIC BEACH, FL 32233
'PtD;i>>%' INSPECTION PHONE LINE 247-5814
FENCE WALL OR BARRIER - FENCE
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: FNCE18-0100
Description: 6' Fence
Estimated Value: 0
Issue Date: 10/5/2018
Expiration Date: 4/3/2019
PROPERTY ADDRESS:
Address: 598 SEASPRAY AVE
RE Number: 170703 0432
PROPERTY OWNER:
Name: LEPPO JOSEPH L
Address: 598 SEASPRAY AVE
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name:
Address:
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions
applicable to this property that may be found in the public records of this county, and there may
be additional permits required from other governmental entities such as water management
districts, state agencies, or federal agencies.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
NOTICE OF COMMENCEMENT
(PREPARE IN DUPLICATE)
Permit No. FFNCE 18-0100 Tax Folio No.
State of Florida County of Duval
To whom it may concern:
The undersigned hereby Informs you that improvements will be made to certain real property,and in
accordance with Section 713 of the Florida Statutes,the following Information Is stated In this NOTICE OF
COMMENCEMENT.
Legal description of property being improved: 35-64 17-2S-29E SEASPRAY LOT 33 BLK 4
Address of property being improved: 598 SEASPRAY AVE ATLANTIC BEACH,FL 32233
General description of Improvements: FENCE
/' i Owner LEPPO JOSEPH L
,1v Address 598 SEASPRAY AVE ATLANTIC BEACH,FL 32233
\� Owner's interest in site of the improvement
Fee Simple Titleholder(if other than owner)
Name
Address
Contractor 5Arvt or 4 5 /nt16- —a-,nfiCrZ IFISEIPI{ 'L• LEA'D
Address
Phone No. Fax No.
Surety(if any)
Address Amount of bond$
Phone No. Fax No.
Name and address of any person making a loan for the construction of the improvements.
Name
Address
Phone No. Fax No.
Name of person within the State of Florida,other than himself,designated by owner upon whom notices or other
documents may be served:
Name
Address
Phone No. Fax No.
In addition to himself,owner designates the following person to receive a copy of the Lienor's Notice as provided in
Section 713.08(2)(b),Florida Statutes.(Fill In at Owner's option).
Name
Address
Phone No. Fax No.
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a
different date Is speciified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Signed: .. DATE 10/5/2018
Before me 5 day of Of`TORF' —.- - I e
Cou ty of Duval S: ,of Florida,has. :.. ,erein by, E D.SMS
Doc#2018237978,OR BK 18554 Page 1258, S I �'
himself/herself ar•e rine that all s;:marts tl•'> e
Number Pages: 1 are we end accurate r �# W CO issoN 5 Go 255331
Recorded 10/05/2018 09:34 AM, •-:::•-.pry EXPIRES:September 5,2022
i f t;.• . ... Nt>fary RID1C lhtderwrRers
RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
COUNTY ` _ �,,,,;,
\ `0AP
RECORDING $10.00 ,� /
Not: u.lic at Large,St of s s- mot IJWI.1
4ti mission expires: ep ems ,.02i
ally Known or
ced Identification Fi.171.
Permit Conditions Page 1 of 1
Enter Permit Number FNCE18-0100 View Report
ya 4 1 of 1 i> P0)1 f} 100% v Find I Next iii4' ii, a
�(11T`Tj
Permit Conditions
l '- f)
u - ___} City of Atlantic Beach
Permit Number: FNCE18-0100 Description:6'Fence
Applied:9/7/2018 Approved:10/4/2018 Site Address:598 SEASPRAY AVE
Issued:10/5/2018 Finaled: City,State Zip Code:Atlantic Beach,Fl 32233
Status:ISSUED Applicant:<NONE>
Parent Permit: Owner:LEPPO JOSEPH L
Parent Project: Contractor:<NONE>
Details:
LIST OF CONDITIONS
SEQ REQUIRED . SATISFY
NO : ADDED DATE : DATE DATE TYPE : STATUS :
DEPARTMENT : CONTACT: REMARKS:
1 9/12/2018 ON SITE RUNOFF INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
All runoff must remain on-site during construction.
2 9/12/2018 ROLL OFF CONTAINER INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
Roll off container company must be on City approved list(Advanced Disposal,Realco Recycling,Shapell"s,Inc.,Republic Services,Donovan Dumpsters).
Container cannot be placed on City right-of-way.
3 9/12/2018 RIGHT OF WAY RESTORATION INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
Full right-of-way restoration,including sod,is required.
4 9/12/2018 FENCING REMOVED INFORMATIONAL
PUBLIC WORKS Scott Williams
Notes:
All old fencing must be removed from job site by Contractor.
Printed:Friday,05 October,2018 IP
TFINGT
1 of 1
http://atlanticbeach.trakit.net/trakit/DocumentV fewer.aspx?&report=/Documents/PERMIT... 1 0/5/2018
1
s?SXLyf�r, City of Atlantic Beach APPLICATION NUMBER
d
� t, , *, Building Department Et '� (To be assigned by the Building Department.)
(� 800 Seminole Road E P• t le 01 O0
. ;, Atlantic Beach, Florida 32233-544 nJ
ir)
Phone(904)247-5826 • Fax(904 7- 10 2018
- q
!J;31s)'' E-mail: building-dept@coab.us Date routed: / 7/fp
City web-site: http://www.coab.uso
APPLICATION REVIEW AND TRACKING FORM
Property Address: 578"g S2SYt2i,/ e Department review required Yes No
Buil in
Applicant: 440 Me, 0 Planning &Zoni
Tree Administrator
Project:
t (ublic Work
Public Utilities
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: Approved. I 'Denied. Not applicable
(Circle one.) Comments: %
�
BUILDING �/
PLANNING &ZONING ���(^
Reviewed by: Date:9ll�/�
TREE ADMIN. Second Review: roved as revise
App ❑Denied. [Not applicable
PUBLIC WORKS Comments: .
PUBLIC UTILITIES '
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. I (Denied. [Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
City of Atlantic Beach APPLICATION NUMBER
::II::II:I/1
Building Department (To be assigned by the Building Department.)
800 Seminole Road
I�Nc_El 00
Atlantic Beach, Florida 32233-5445Phone(904)247 5826 Fax(904)247 5845 /7�'E-mail: building-dept@coab.us Date routed: //
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 5 (ff Seaspi1 Ave. Department review required Y No
Bui
Applicant: 'NQ me U 1lfn _, _P anning &Zoni
/ Tree 'dministrator
Project: l9 � Public Works
Public Utilities
Public Safety
Fire Services
'Review fee $ Dept Signature I
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: I ''i pproved. ['Denied. nNot applicable
(Circle one.) Comments:
UILDIN
PLANNING &ZONING
Reviewed by: Mr)/ Date: Vol 0k
TREE ADMIN. Q
Second Review: Approved as revised. I (Denied. ['Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES '
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ['Denied. I 'Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
iL:.Lyfje, City of Atlantic Beach APPLICATION NUMBER
6' , ,, Building Department (To be assigned by the Building Department.)
(, 800 Seminole Road �(
�.. _ ,2 Atlantic Beach, Florida 32233-5445 �Iv�� 01 0d
-��. .. . Phone(904)247-5826 • Fax(904)247-5845
timet q
^�o;; 9? E-mail: building-dept@coab.us Date routed: / 7//k
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 578"8" Sasppt1 � De artment review required Yes No
Buil
Applicant: 440 Me Ottinee., Panning &Zoni
Tree dministrator
Project: i FejiCe- Public Work
Public Utilities
Public Safety
Fire Services
;Review fee $ Dept Signature 1
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: Approved. I (Denied. [Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING q p
Reviewed by: .11-4— Date: / -7 r I O
TREE ADMIN. Second Review: Approved as revised.
pp ❑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 05/19/2017
! % Building Permit Application Updated 12/8/17
$ ' City of Atlantic Beach
VW, 800 Seminole Road,Atlantic Beach,FL 32233
G Phone:(904)247-5826 Fax:(904)247-5845 A )�/
Job Address: 5q0 SSS Y AV Permit Number: !v w�/��v160
Legal Description L 3� BL,. 4SOe4 1 RE# / tC 03 --b 932-
Valuation of Work(Replacement Cost)$ 252x) Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial Residential
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed:
to PAe--/ 12--ErtAto E1c1ST/L)(j 6 ' Pe)v&c / t . 3oCKYA€P
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: - O3 'l-1 1-• LPPV Address: 590 - Seg--4-`i A-Vg.
City ATL.AArTtL &4 // State FL- Zip 32Z 33 Phone gc ' z42 —
E-Mail Lf Fo'SL( i-10NI4 L. . C-Dfl.I
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) CYW#VCS.
Contractor Information
Name of Company: Qualifying Agent:
Address City State Zip
Office Phone Job Site/Contact Nur
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation
xempt/Insurer/Lease Employees/Expiration Date
Application is hereby made to obtain a permit •. do the work and installations as indicated.I certify that no work or installation has
commenced prior to the issuance of a per and that all work will be performed to meet the standards of all the laws regulationg
construction in this jurisdiction. I under .nd that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS,
WELLS, POOLS,FURNACES, BOILERS, ATERS,TANKS, and AIR CONDITIONERS,etc. NOTICE: In addition to the requirements of this
permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and
there may be additional permits required from other governmental entities such as water management districts,state agencies,or
federal agencies.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all
applicable laws regulating construction and zoning.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
(Signature of Owner or Agent) (Signature of Contra •
(includin ontractor) ►�
Signed and sworn to(or affi )before me this / day .f Signed and sworn to(or affirm-. before me this day of
,2 ,b O O-%I L ' • 1a ..
(:2) 4741111k
(Signature o Notary) (Signature of Notary)
[ ]Personally Known OR
Produced Identification ( y'' p-qweitifiltEMEWfitificati
Type of Identification: I_ J a EXPIREAS:October 6x26 : I
;P °.' Bonded Thru Notary Public Underwriters
01,1-v ffr, City of Atlantic Beach APPLICATION NUMBER
d ti•:,fr�-:,i, Building Department (To be assigned by the Building Department.)
'`',(1J • 800 Seminole Road �1�'� At /O�
..ta Atlantic Beach, Florida 32233-544
�` • ' _. P/v�l O1
Phone(904)247 5826 Fax(904) 7 5845 /
,k,._01110-. V E-mail: building-dept@coab.us O j z} Date routed: 1 /7
City web-site: http://www.coab.us
APPLICATION REVIEW-AND-TRACKING ACKING FORM
Property Address: 5 /ff SeQspf2 / Pale- Department review required Yes No
Buildi
Applicant: 4-101)16 0 Panning &Zoni
Tree dministrator
Project: t ReliCe
Public Works
Public Utilities
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: I 'Approved. Venied. I 'Not applicable
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed b ate: ,...42.4
TREE ADMIN. Second Review:
✓Approved as revised. ['Denied. ❑Not applicable
PUBLIC WORKS Comments: .
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:��ea,derfee,,,,,x. Date: 4-2�1�
FIRE SERVICES Third Review: ['Approved as revised. ['Denied. ❑Not applicable
Comments:
Reviewed by: Date:
Revised 05/19/2017
�- i* ��� ECM; TLANTIC BEACH
i-•. ' `;d,�J VV 800 Seminole Road
-",,t,_
,- t OCT Q Atl c Beach,Florida 32233
;� 201
',ortW
REVISION REQUEST I CORRECTIONS TO PLAN REVIEW COMMENTS
Date C112k'113 Revision to Issued Permit VCorrections to Comments Permit# r h,lce 0 -DI 00
Project Address Sib SeA SP12Ay I V►_
Contractor/Contact Name
Phone ' ( ; ) 2-Li 2 - `f b g ci Email r0 S t— e Tri A tiL. C-0 fn
Description of Proposed Revision/Corrections: Permit Fee Due$
RAJ F. KJcc
Additional Increase in Building Value$ Additional S.F.
By signing below,I affirm the Revision is inclusive of the proposed changes.
(printed 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
Department Review Required: ,
Building � 1 -
Planning &Zoning eviewed By
ministrator
Public Worcs
u is hies 4.—.70—/e
Public Safety Da
Fire Services
REVOCABLE ENCROACHMENT AGREEMENT
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation
organized and existing under the laws of the State of Florida, hereinafter referred to as"CITY"and
bs'PH L. LE--PD of Atlantic Beach,Florida, hereinafter
referred to as"USER".
WITNESSETH:
That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon the
property for the purpose as described in the City of Atlantic Beach.
This work is generally described as Fet.)C
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to
relocation or removal on thirty(30)days' notice by CITY to USER, said notice to USER shall be given by certified mail,
return receipt requested,to the following address SR 9ft-SPR 4-`1 Ave
• In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter
upon the above described easement or property of the CITY,the USER shall replace at the USER's sole expense,
any and all material necessarily displaced during the action of maintaining,repairing,operating,replacing or adding
to of the utilities and facilities of the CITY or franchise utility provider.
• The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes, Land
Development Code and all other land use and code requirements of the CITY, including City Code Section 19-7(h)
which states"Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but must
be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks."
• The USER,prior to making any changes from the approved plans and/or method,must obtain written approval from
the City of Atlantic Beach Public Works Department, for said change within 30 days after the day of completion.
• This permit shall inure to the benefit of,and be binding upon,the USER and their respective successors and assigns.
• USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or
specifications,to include utilities locate requirements and use limitations/requirements of easements, public right-
of-ways and other public land. USER further agrees that the CITY and its officers and employees shall be saved
harmless by the USER from any of the work herein under the terms of this permit and that all of said liabilities are
hereby assumed by the USER.
1 Date Z$ L
C-.--
Property r/ gent(signed in presence of Notary Public)
25
STATE 0 IDA,COUNTY OF DUVAL �
The foregoing instrument was acknowledged this day of SP--12 76i F32 ,20 1 ,
by �oscr-hft 1 L6-°PO ,who personally appeared before me and
(printed name of Signer)
acknowledgedth a/she signed the instrument voluntarily for the purpose expressed in it.
gnature of Notary ublic, State of Florida
Department Approval:
Personally ••
Produced 4 H@yon(T�p • s ' /�
:.: t : MY COMMISSION 0 GO 256331 `f. .47,41e....)dieded.....‘spe.,
+a
- .'a' EXPIRES:Septeeiber5,21Y22 Scott Public Works Director
';','. ?,'•'•'-'RBonded Thru Notary Public Underwriters Williams,
o:\publicWorks\ADMIN\Revocable Encroachment Agreement.docx
Revision Date:8/31/18
' CITY OF ATLANTIC BEACH
Department of Public Works
-- 1200 Sandpiper Lane
Atlantic Beach, FL 32233
(904) 247-5834
PUBLIC WORKS PLAN REVIEW COMMENTS
Date: 9/12/18 Applicant: Joseph Leppo
Permit #: FNCE18-0100 Email: leppojl@hotmail.com
Review Status: DENIED Site Address: 598 Seaspray Avenue
THIS PLAN REVIEW IS ONE OF MULTIPLE DEPARTMENT REVIEWS
Correction Items must be submitted to the Building Department at 800 Seminole Road.
Submittals that respond to only one or a few correction items will not be accepted.
Revisions may not be submitted until ALL departments have completed their respective reviews.
Revisions must be submitted to the Building Department and must respond to EACH department review.
PUBLIC WORKS CORRECTION ITEMS:
• A Revocable Encroachment Agreement must be submitted.
The form is on our website under Building Department - "Permit Applications and Forms"
and also at the Building Department located at City Hall.
APPROVED
PUBLIC WORKS CONDITIONS OF APPROVAL:
(The following comments will be printed on your permit as Conditions of Approval) a iv-%2'fe
• All runoff must remain on-site during construction.
• Roll off container company must be on City approved list (Advanced Disposal, Realco
Recycling, Shapell's, Inc., Republic Services, Donovan Dumpsters). Container cannot be
placed on City right-of-way.
• Full right-of-way restoration, including sod, is required.
• All old fencing must be removed from job site by Contractor.
Scott Williams, Public Works Director swilliams@coab.us/904-247-5834
Resubmittal Notes: All revisions and changes shall clearly stand out from the rest of the drawing on the sheet as a
revision by way of completely encircling the change with "clouding". The revision shall also be identified as to the
sequence of revision by indicating a triangle with the revision sequence number within it and located adjacent to the
cloud. The revision date and revision sequence number shall also be indicated in a conspicuous location in the title block
for each sheet on which a revision for that sequence occurs. For projects still in the initial review stage and permit
pending, all sheets with revisions shall be inserted into each set of drawings. The original sheets must be clearly marked
"VOID" but are to be left within the set of drawings. Complete new sets of drawings will not be accepted. ADDITIONAL
ITEMS MAY BE REQUIRED DEPENDING UPON NEW INFORMATION AND CLARITY OF FINAL PLANS SUBMITTED FOR
REVIEW.
Page 1 of 1
0:\Public Works\ADMIN\PLAN REVIEW COMMENTS\FNCE18-0100(Owner-Leppo).docx
MAP SHOWING BOUNDARY SURVEY OF
LOT 33 BLOCK 4 ACCORDING TO THE PLAT OF
SEASPRAY
AS RECORDED IN PLAT BOOK 35 , PAGE(S) 64 OF THE CURRENT
PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA.
1/2"
IRON PIPE
4"X4"
CONCRETE
MONUMENT d��
��t \ ; ON UNE S
go �1-Its. (4 �x.' WITH WALK �7IwA
•
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'� <m .. 41.Try•Q, BLOCK 4
COMMUNITY MUNITY DEVELOPMENT N .. o LOT-33 „•
Y BLOCK 4 • �,
APPROVED m _ lo
•
0.8' .. . L algSX- 190-e Tr:
P,al,e/124i3OUlct PU i ai.
UNE I 0• .; IRON PIPE 1.1'•--/ 7 i-9
_ n ■ a
1/2 I FENCE 20' EASEMENT FOR DRAINAGE,/ b
*{tyJ r'N� REBAR I . IRON PIPE + r ONLINE ( —
r r.8' r UTILITIES a SEWERS
t-V LI-ow S A GTvp L, 0.1'-' I r— — — — r
?T U/oil /• S 82'26'50" W 41.72'6 (M) •` LOT-24
PeUP6 . � I s' 10' I S 82'28'36" W
1 I 41.71' (R) BLOCK 4
REFERENCE JOB NO. 66334 LOT-23 BLOCK 4
l_01-1) SELT/oAi DArHA4g0/1)4; 'rev j,0 IA./ FhZL ZD).3._ Huce,c,9
10V
IA/.
TREE & VEGETATION AFFIDAVIT
City of Atlantic Beach
I1, vI Department of Community Development
Planning&Zoning Division
800 Seminole Road Atlantic Beach,FL 32233
(P)904 247-5800 (F)904 247-5845 PERMIT.
SECTION I-APPLICANT INFORMATION Owner(s) r- Legal Authorized Agent*
NAME OF APPLICANT L.. `- t'
NAME OF COMPANY
ADDRESS OF COMPANY
PHONE CELL EMAIL
CONTRACTOR CERTIFICATION NUMBER
ATLBCH BUSINESS TAX RECEIPT NUMBER
SECTION II -SITE INFORMATION
STREET ADDRESS OF PROPERTY 5q 8 S.Sl3z'4y 4 v
lion address has not been assigned to this property,contact the AB Building Deportment at(904)247-5826 to request an address.
LEGAL DESCRIPTION
LOT 3 3 BLOCK 4- SUBDIVISION Sf4ct4"1
REAL ESTATE NUMBER 11'6463 --0(/3 . LOT OR PARCEL SIZE: SQ FT AC
RESIDENTIAL COMMERCIAL 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 t escribed or adjacent properties in conjunction with this project.
SIGN URE OWNER SIGNATURE OF OWNER
Signed and sworn before me on this day of 3sP ,2Ot ,,by State of
County of
Identification verified: L _ Z_ 7 0 8s0— 0
Oath sworn: Yes
(- r No 4
09
TONI GINDLESPERGER
1,:';'''17;,-t,:‘
. MY COMMISSION if FF 924951 , Nota gnature
- •.,x` ..a EXPIRES:October 6,2019 ,
1 t
Bonded Thru Notary Pudic Underwriters
RE 144;16 � My Commission expires: