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2409 Seminole ROW18-0038 City of Atlantic Beach APPLICATION NUMBER Building Department o be assigned by the Building Department.) 800 Seminole Road Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 Fax(904)247-5845 OCT 18 2018 ate routed: E-mail: building-dept@wab.us City welb-site: http:1A�.00ab.us PPLICATION REVIEW AND TRACKING FORM Z Z409 roperty I di ess: Z4 00 2:) Department review required Yes No Buildin Applicant: zaiMning &Zon�g Project: Re'--Ackae so/svi lgpislI5 c 0 Public Sa—fety Fire Services Other Agency Review or Pennit Required Review or see It of Permit Verified By Date Flonda Dept.of Environmental Protection Fluids Dept.of Transportation St.Johns River Water Management District Amy Corps of Engineers Division of Hotels and Restaurants Division af Alcoholic Beverages and Tobacco Other: APPLICATION STATUS Reviewing Department First Review; DApproved. E]Denied. orot applicable (Circle one.) Comments: BUILDING PLANNING&ZONING el LIZ Reviewed by �-�Date: /0-1 -f TREEADMIN. Second Review: CAppmved as revised' [-]Denied. []Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date* FIRE SERVICES Third Review: DApproved as revised. []Denied. [-]Not applicable Comments: Reviewed by: Date:— Revised 0511912017 003(S RIGHT-OF-WAY/EASEMENT PERMIT Permit#Issued by the City of A thim tic Beach PERMITTEE RESPONSIBLE FOR NOTIFYING S I I AND OBTAIYING UTILITY LOCATES Job Address 7A9 ) Sep,,W le Rel, PIIQne--1&fa225-3-- permittee O'V14 Email Requesting Permission to Construc_ ?�pljyz (l) -913we7�-�, Location(Refererice to Cross-Strect) OceA, drnek-j2- • Penmittec declares that prior to filing this application they haw ascertained the location of all existing utilities, both a.ri.1 and underground and the arsouraft locations are shown on the sketches. • Whenever necessary for the construction,repair,impmvement,maintenance,safe and efficient operation, alteration or relocation of all,or any portion of said street a,casement as determined by the Dirsmir of Public Works,my or all said poles,wines,pipes,cables or other facilities and appurtenances authorized lumunder,shall be immediately removed ftom said street or eitamment or reset or=located hereon as required by the Director of Public Works and at the expense of the permutes unless reimbursement is authorized. All work shall meet City of Atlantic Beech or Florida Depimment ofTransportartion Standards and be perfornied under the supervision of 1Z, st�,4ajf, (Pniject Superintendent) with Company Name TG/q Phana__I��. All materials and equipment shall be subject to inspection by the Director of Public Works. All city property shall be restored to its Original condition as far as practical,in keeping with City specifitations and the manner satisfactory to the City, A sketch ofplam;covering details of this instaflation.as well as a copy of a recent survey shall be mile a pan ofthispearraft. Calculations showing any increase In impervious area on owner's lot or in the City right-of-way are to be included with this application- The peurnittee shall commence actual construction in good faith within_days, If the beginning date is mom than 60 days from data of permit approval then permime must review the permit with the Director ofPublic Works to make sure or,changes have occurred in the area that would affect the permitted construction. It is understood and agreed that the rights and privileges herein set out am granted Only to the remain Of the City's right,tide and interest in the land to be entered upon and used by the holder,and the holder will,at all firses, assume all risk of and indemnify,defend and as ve harmless;the City of Atlantic Beach from and against my and all loss,damage and cost of expenses arising in any mamm,of the exemise or attempted memise,by the holder of the aforesaid rights and privileges. TbeilDirector of Pu"Works shall be notified twenty-four(24)hours prior 0 sterling work and again letion. Data— Permithre(signed in puTencefif Notary Public) S FATE OF FLORIDA,COUNTY OF DUVAL The foregoing instrument wea;acknowledged this�day of .20— by �h.p�...l ly appeared Wfm me it (printed name of Parritme) acknow1cdged that haahe aisoad the instminent vol untuily for ffic pun,�c exPmaecd in it Personally Known Signature of Notary Public,Store of Florida Produced Identificati.ri(Type) ENGINEERING DESIGN ORACLE PERMIT MA)aMO DATE REL PROJECTM 35862 N.O.: 8005213 WO M 30358150 CONST 101`171`18 CIR. TREE TRIMMING SUB-STA: NEPTUNE BEACH N.O.: 565 REOrD:YES CELL ENGINEER:Robert Simpson N.C.: NIA ZIP CODE: NIA CUSTOMERI Svc PHONE LOCATION:2401SEMINOLE RDJ/POLE AND TRANS REPLACEMENT 56!CENTER:SSSC N.O.:665-7793 1 1 i STA 1. P# 2409 SEMINOLE RD./ R&R N 5013W, REPLACE 25KVA WITH 76KVA. STA 2, P# 2401 SEMINOLE RD./ REPLACE OH 50/25KVA WITH 75150KVA OPEN DELTA. ***** TREE TRIMMING REQUIRED***** 2431 AR-444 N.O. 2431 G-196 STA 1 2409 75A Lu 0 STA 2 z C:] 121 115 109 91 71 51 2401 50A 75C 2377 100T C�,A LU OCEA SREEZ DR NJ ---------- ------1 MR I B c .IrA. CM eeortS Estimate Number:35862 2409 SEMINOLE RD./51 POI-E Estimate Type:SR Confinnot:069-1 6-HM OR 1�1 8 REPLACEMENT Estimate Version: Dr. SIMPRIB MIMOINI'al 3035810 Required Dall Oulde Pmlect#:8ON212 Estimal 10,117=18 Cost Estimate Materials JEA Connector 1.New Material Cost(WI sales tax) $2,058.08 $ZW8.08 2.Transformer Cost W Sales tax) $5.173.25 $5.173.25 3.Returneal Materal Salvage Value $0.00 $0.00 Labor 4.Crow,Time S2.016.W S2.670.24 S.Extracrofireary costs S0.00 $0.00 JEA Onnari 6.Filings Benefits(54.56%of lines 4&7) $1.252.01 $10.10 7.Engineering Costs(Variable%oF Has 4) S279.40 Jil S.Pro,ent Equipment Costs(40%of Joel equipment costs) $1,199.58 $0.00 9.Materiel Handling(8.30%of lines I It 2) $601.03 $601.03 10.lospeaction(6.84%of Jim 4) $0.00 $1l 11.Total Cost Of PrqJ $12,588.68 $11.250.76 12.Woll,Order Estimate(Line 11 minus Him B.9.&10) $10.7811.07 $10,649.73 13.Billable Equipment Depopeoinficon(60%of total equipment costs) $1.7519.37 $0,00 14.Billing Estimate(Including Transfornmer Cost)(Lines 11+13+(WY1%of 4&7)) $15.7H29 $11.asi.� 15+Billing Estimate(W/O Transformer Cost)(Lines 11+13+(68.71%of 4&7)-Los 2� $143.02.04 $6.288.52 Time Estimate C,Hotins Total Maprours 16.18 64.64 -------------------------------------- JEA. Cut— e 0 Elitinate Nunubdr 2409 SMINME RDJ 51-ROS Estimate Type SR Contract(189-16-11M OH�18 REPIACEIVIENT Esdmaw,Varl By: SUPRO "OWask:30358150 Required Dad: Omcls Projed 11:W05212 allmaW On: 101171410 CU Detail Station: 01 2409 SEMINOLE RD Build �.ndft, amain In Pine DGAC'75 1 DHLC*410CU I F11-H*21 3 GIW*2 1 P.50/3W 1 RUISLIP 8 S20ES*4104/0 2 S9*2 2 S9*4/0 6 TI*4/OCU I ANCHOR I ARRESTER 4 BANK10 1 CLAMP 3 CUT 4 CUTOUT 1 DESHOE 2 DEYE 2 DOWN318 1 EYENUT 2 FULLGRI) I GUARD I NUMBER 1 P.50/3w 1 PIN 3 POLECON 2 PRINS 3 RUBDOWN 8 SARIVIDIST I SEC I SECINS I SMWEDGE 2 STANDOFF 3 SWITCH 1 CUE Reports E.N.M.Wmb.l 35862 2409 SEMINOLE RDJ 50KNV POLE Estimate T,,xf:SR Contraft 069-16-HM OH�18 REPLACEMENT Estinnsda Version: By: SIMPRB MWONTask:30358160 Rec,uineal Date: Ora�Projeat#:BMU12 Estimancsf On; 10117=18 Station: 2 2401 SEMINOLE RD. BuUd Transfer Assess—R... DGBC*75-50 1 RUISLIP a $20ES*4/0-2/0 2 S9*2 4 S9*410 4 SEVF I BANK20 1 POLECON 2 RUBDOWN 8 SMWEDGE 2 USRW*2JO 2 ,KA CUE Reports Estimate Numbsl�35862 M9 SEMINOLE RDJ W�W POLE Estimate Type.SR C��tr.�t:089-16-HM 014 FY 18 REPI.ACEMENT Estimate Version. By: SIMPRB MWO�ask-W3581 50 R"Wrati Date: Orade PnJect#:WOU12 E.11re.bectOm 1011M018 Material Summary ftemquandia, IW.Ntjorbor hemp...dows, 6 ARRL1003 ARRESTER, LIGHTNING, 18 KV,DISTRIBUTION CLASS AND RISER POLE(MOV)WITHOUT MOUNTING BRACKET, 15,2/26.4Y NOMINAL VOLTAGE I BAYSW004 BAYONET,SHIELD WIRE.STRAIGHT 40'LENGTH 3 BKTAC003 BRACKET.ARRESTER OR CUTOUT,CROSSARM MOUNTED,SIZE 5- a/4"X 5-314" I BKTAC009 BRACKET.ARRESTER AND CUTOUT, FIBERGLASS WITH RAYCHEM MATERIAL OVER ROD TYPE:SINGLE PHASE 1 BKTAC010 BRACKET,ARRESTER AND CUTOUT,FIBERGLASS WITH RAYCHEM MATERIAL OVER ROD TYPE:THREE PHASE 2 BKTTMOOI BRACKET,TRANSFORMER MOUNTING,SINCLE MOUNT 2 BOLMS002 BOLT,MACHINE, 1/2"X 7-, SQUARE HEAL)GALVANIZED.51 LEL, WISQUARE NUT ATTACHED, (MUST BE SHIPPED IN STD. BOX QUANTITIES OF 100 EACH) 2 BOLMS015 BOLT,MACHINE.518"X 2",SQUARE HEAD GALVANIZED STEEL, W?SQUARE NUT ATTACHED, (MUST BE SHIPPED IN STD. BOX QUANTITIES OF 150 EACH) 1 BOLMS020 BOLT,MACHINE,5/8-X 14%SQUARE HEAD GALVANIZED STEEL, W/SQUARE NUT ATTACHED, (MUST BE SHIPPED IN STD. BOX QUANTITIR 0 2 BOLMS029 BOLT,MACHFINEEW SQUARE HEAD GALVANIZED STEEL. WISQUARE NUT ATTACHED, (MUST BE SHIPPED IN STD. BOX QUANTITIE 0 101) C Z5E HF_E_ NE,�7 4� 7 BOLMS035 BOLT,MA 12�, SQUARE HEAD GALVANIZED STEEL, W/SQUARE NUT ATTACHED; (MUST BE SHIPPED IN STO.BOX QUANTITIES OF 25 EACH) 4 BOLMS036 BOLT,MACHINE,3/4-X 14",SQUARE HEAD GALVANIZED STEEL, WISQUARE NUT ATTACHED, (MUST BE SHIPPED IN STD. BOX QUANTITIES OF 25 EACH) 1 BOLMS037 BOLT,MACHINE,3/4'X 16-, SQUARE HEAD GALVANIZED STEEL, W/SQUARE NUT ATTACHED, (MUST BE SHIPPED IN STD.BOX QUANTITIES OF2 CH 24 BOLTE001 BOLT,TERMIWAFK�T�(KILT INCLUDES)1-EACH 112'DIA.X 2"S/S BOLT FULL THREAD,2-EACH SIB FLAT WASHERS. I-EACH SIS BELLEVILLE 1-SILICON BRONZE NUT(SHIPPED IN BAGS OF 10-EACH ASSEMBLED)-'(SEE SPECIFICA nON)" 18 CAIRHO10 CABLE, NO.4 SOFT DRAWN SOLID COPPER,COVERED TAP WIRE WITH LAYER OF FLEXIBLE,BLACK,THERMOPLASTIC ELASTOMER INSULATION(SHIPPED IN 2DO FOOT HAND COIL)(20,000 FT MIN ORDER) 1 CLAGROOI CLAMP. GROUND ROD. 5/8'-4SOL"HAMMERLOCK" 1 CLAHL001 CLAMP, HOT LINE,6-1/0-MAIN,6-1/0-TAP 4 CLASR002 CLAMP,STRAIN RELIEF WEDGE,ALUMINUM, 11IJ TRI-41U PAP I CLASWOOI CLAMP,SHIELD WIRE,3#6AW 1 3#7CU,U V 3 CLATGO01 CLAMP,TRANSFORMER TANK GROUNRUBONZE'6 SOL-I STR. 15 CNNCP002 CONNECTOR,#2,6-2 MAIN,2-1/0 TAP,ALUMINUM COMPRESSION, jrA. CUE Reports Estimate Number 36862 24M SEMINOLE RDJ 51)�W POLE Estimate Type,SIR Contract 089-16-HM OH FY18 REPUttCEMENT EsImmle vamim! BY. SIMPR8 IWOtATask-30358150 Required Date: Orade Projed 8MU12 EstimateelOn 10117=18 PARALLEL TAP, 6 CNNCP006 CONNECTOR,#6, 1/0-211)MAIN,310-410 TAP COMPRESSION, PARALLEL TAP,ALUMINUM, 26 CNNCP007 CONNECTOR,#7,310-4/0 MAIN,3/0410 TAP COMPRESSION, PARALLEL TAP,ALUMINUM, 2 CNNGRO02 COUPLING, GROUND ROD.'THREADLESS'REMARKS: FOR THREADLESS GROUND RODS 6 CNNTS006 CONNECTOR,TRANSFORMER BEZ50NDARY SET SCREW TYPE W/INHIBITOR,4-HOLE NEMA RANGE: 10-500,3-PORTS. 2 CNNTS009 CONNECTOR.CONTAMINATED ENVIRONMENT,TRANSFORMER SECONDARY SET SCREW TYPE WITH INHIBITOR, 1/2"STUD,RANGE: 12,350,6-PORTS. 10 CNNVG003 CONNECTOR,6-2 SOL110-2 SOL,VISE GRIP PARALLEL,BRONZE 2 CNNVG006 CONNECTOR, 110-4/0/10 SOL-410,VISE-GRIP PARALLEL,BRONZE 12 COBC0025 CONDUCTOR,#6 SOLID,SOFT DRAWN, BARE COPPER, 315%25#.ON PLASTIC REEL,4 H X 11.51'W/2H HOLE 83 COBC0028 CONDUCTOR,#4 SOLID, soFr DRAWN,BARE COPPER,200',25#,ON PLASTIC REEL,4'X 11.6-Wl 2-HOLE 2 COBC0029 CONDUCTOR,#2 SOLID, HARD DRAWN, BARE COPPER(25# COIL)126 70 COBCW014 CONDUCTOR.#4,TYPE 40 OSA,COPPERWELD&COPPERWELD- COPPER.204"DIAMETER 1480#BREAKING STRENGTH (50#COIL- 427') 66 COVIC002 COVER, 'D"DIE,INSULATING,2-1/2" 3 CUTOT006 CUTOUT,CONTAMINATED ENVIRONMENT,26"LEAKAGE DISTANCE TO GROUND, 100A,27 KV, 170 KV BIL I CXAFG002 CROSSARM.FIBERGLASS,4 518-X 3 518AN0. WMuNG,39 LES, USED FOR TANGENT CONSTRUCTION ONLY I FUSOH024 FUSE, OVERHEAD DISTRIBUTION,3.1 AMP,TRANSFUKMtK. 2 FUSOH026 FUSE,OVERHEAD DISTRIBUTION,5. AMPbTRANSFORMER BE W TH ER61Z 3 GUAAN002 GUARD,ANIMAL,MINI SHED MOUNT, F ED TRANSFORMERS AND ARRESTERS,TO BE INSTALLED AROUND FIRST SKIRT ONLY I GUAGWO01 GUARD,GF�OUNDWIR_E 12"X 1/2"X 96", GRAY PLASTIC R,VERTjC7�LoL_ -KV,J/4-5 1 UU I AP 3 INSVP001 INSULATO OST,TIE TOP 35 STANDARD PACKAGING IS NOT TO EXCEED THREE UNITS OR 72 POUNDS. 6 NUTSL003 NUT,LOCK,SQUARE,518"HoLIE SIZ5,J9T DIPPED GALVVAANIZED -BULT 51 1� H :r DI P W 8 NUTSI-004 NUT, LOCK,SQUARE,3/4 ED GAL I POLW0009 POLE,WOOD, 50'CLASS 3 (TIL=2 . EIGHT 2,44;LBS 3 RODGRO03 ROD,GROUND,THREADLESS,Wd�X 3%SHIP ON OPEN -i-A I BE5 ONLY] 6 SLEAL002 SLEEVE,ORANGE TO ORANGE NEUTRAL 4.4 ALUMINUM TRIPLEX NEUTRAL SPLICING 10 SLEFT006 SLEEVE,4/0 7-STR AAAC, FULL-TENSION ALUMINUM.COMPRESSION TYPE 3 STUL1003 STUD,LINE POST,DIA.SHANK-3/4',SHANK LENGTH-7-. GALVANIZED STEEL WITH NUTS AND WASHERS;3/4"HEAD SIZE, ,A&'l CUE Reports Estimate Numbw:35862 2409 SEMINOLE RDJ W13W POLE EsIsm.t.T,,.:SIR 069-1�HM OR FY 18 REPLACEMENT Esilmahe Version: By: SIMPRI3 MWO�ask:W358150 Required Date: Oracle Pr*ct W 80OU12 E.firasted Oat 10117=18 1 TAGH0007 ALUMINUM VERTICAL TAG HOLDER FOR ADHESIVE BACK CHARACTERS((NOT FOR 'SLIDE IN"CHARACTERS)). 19-5-HIGH X 2- WIDE WITH 3-1/8"NAIL HOLES @ THE TOP AND THE BOTTOM. (PKG. OF 50 EACH) 1 TRAC0002 TRANSFORMER, 50 KVA, 14760/25565Y VOLT PRIMARY, 1201240 VOLT SECONDARY,SINGLE PHASE,CONTAMINATED ENVIRONMENT-JEA SPECIFICATION REQUIRED 2 TRAC0003 TRANSFORMER,75 KVA, 14760126565Y VOLT PRIMARY, 120/240 VOLT SECONDARY,SINGLE PHASE,CONTAMINATED ENVIRONMENT 4 WASRDD03 WASHER,ROUND, 112-BOLT SIZE X 1 319-DIAMETER,GALvANIZED. (100 EACH PER BACUBOX). 8 WASRD004 WASHER,ROUND,518-BOLT SIZE X 13/4"DIAMETER,GALVANIZED, 650 EA PlBOX) 21 WASRD005 WASHER,ROUND.314'BOLT SIZE X 2"DIAMETER, GALVANIZED, 5DO EACH PER BOX*** 2 WASSF001 llff� MME �T!I IX 141 1 "7 ER�� ; 12;12L �11LGALVANIZED SZ,UARE;L LAT JT 8 34 9 WASSF003 WASH 14 BID UILL. GALVANIZED 9 WASSP002 WASHER,SPRING,314'p BOLT SIZE, DOUBLE COIL HELICAL TYPE, GALVANIZEQWEAVY DUTY) 2 WASSP003 WASHER,5 BOLT SI/t:,L�I- I YPt,LiALVANILLU im CU t 0 Eaftalb,Number W62 2409 SEMINOLE RDJ 5AM—LEPS EstimateType:SR Coreract:08Si6-riMOHFYI8 REPLACEMENT afienate,V.,elem By: SIMPRB MWOWssk:30358150 Reuired Deno: Oracle Prje.t#:SOCK12 Esilmateel On: =7=18 CU Summary lll.lvjlwl� CU Nwo Quanliho D.,mnU.. DGAC*75 1 TRANS;Cl,26.4KV 1201240 75KVA DGBC'75-50 1 TWO-PHASE TRANSFORMER BANK-26.4KV DHLC*4/OCU 1 4/0 COPPER HOT-LINE CLAMP GlW*2 1 WOOD POLE-EQUIPMENT GROUND P.5013W 1 50 Fr.CLASS 3 WOOD POLE RUBLE 16 LINE RUBBER INSTALLATION, PER SECT. S20ES*410-2/0 2 SECONDARY CONNECTION AT POLE S20ES*410-4/0 2 SECONDARY CONNECTION AT POLE S9*2 6 SECONDARY SPLICE 89*4/0 10 SECONDARY SPLICE SIEVE 1 SEVERE CONDITION FOR FRAMING CREW Tl*4/OCU 1 410CU 0 TO 5 DEGREE ANGLE-SHIELDED 0 CU Nem, ..,WIN SmIediallm ANCHOR 1 SINGLE-HELIX ANCHOR REMOVAL ARRESTER 4 DIST.ARRESTER REMOVAL BANK10 1 SINGLE TRANS.REMOVAL,UP TO 75KVA BANK20 I 2-POT BANK REMOVAL, UP TO 75KVA CLAMP 3 HOT-LINE CLAMP REMOVAL CUT 4 CUT POLE OR CROSSARM CUTOUT 1 FUSE CUTOUT REMOVAL , DESHOE 2 NEUTRAL DEAD-END SHOE REMOVAL DEYE 2 S6 REMOVAL DOWN3/8 1 318 IN.DOWNGUY REMOVAL EYENUT 2 EYENUT REMOVAL FULLGIRD 1 EQUIPMENT GROUND REMOVAL GUARD 1 YELLOW GUY GUARD REMOVAL NUMBER I POLE TAG REMOVAL P.50/3w 1 50 FT.CLASS 3 WOOD POLE PIN 3 INSULATOR PIN REMOVAL POLECON 4 S20 REMOVAL PRIINS 3 PRIMARY INSULATOR REMOVAL RUBDOWN 16 LINE RUBBER REMOVAL.PER SECT. SARMIDIST 1 SINGLE DIST.X-ARM REMOVAL SEC 1 SEC.SPOOL INS, BRACKET REMOVAL SECINS 1 SEC. INSULATOR REMOVAL SMWEDGE 4 $MAUL SEC.WEDGE CLAMP REMOVAL STANDOFF 3 PRI.INSULATOR STANDOFF BRACKET REMOVAL SWITCH 1 CUTOUT&ARRESTER BRKT.REMOVAL USRW*210 2 UNDERGROUND RESIDENTIAL SERVICE OH POLE City of Atlantic Beach APPLICATION NUMBER Building Department ECEIVERigned by the Building Department.) 800 Seminole Road ovo Ito) - ()038 Atlantic Beach, Florida 3223 iZ45 OCT 11 2018 Phone(904)247-5826- Fax 247-5845 E-mail: building-dept@wab.us BY:— DatsUted: Cityvveb-site: http:/A�wcoalb.us Z Z \�PPLICATION REVIEW AND TRACKING FORM 20,0 r party Ldress: Z4 oc) )Occ- 22t Department review required Yes No Buildin Applicant: ;ran-nmg&Zomng�j TM-Adff 111iftt"aMr Project: Public Safety Fire Services Review fee $ Dept Signature —Review or—Receipt Date Other Agency Review or Permit Required of Permit Verified By Florida Dept.of Environmental Protection Florida Dept.of Transportation _�L 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: 124/proved. E]Denied. E]Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed la�,_� _:Qate: TREEADMIN. Second Review: ElApproved as revised. E]Denied. E]Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date:— FIRE SERVICES Third Review: E]Approved as revised. E]Denied. ONot applicable Comments: Reviewed by: Date:— Revised 0511912017 City of Atlantic Beach APPLICATION NUMBER Building Department Cro be assigned by the Building Department.) 800 Seminole Road Atlantic Beach,Florida 32233-5445 0�,,J I R - 0 03(s Phone(904)247-5826- Fax(904)247-5845 E-mail: building-dept@wab.us Date routed: City web-site: http:/Mvw.coab.us PPLICATION REVIEW AND TRACKING FORM I Z4 9 Lzrop�� drpess: Z40ose Department review required Yes No Building Applicant: &nning &Zon—ing---, Project: TT69-AdffMn9trat6r -.F'trtg�cor Public Safety Fire Services Review fee $ Dept Signature___1- ————- Other Agency Review or Permit Required Rov=,OO'P'r of Pe ad B Data Florida Dept.of Environmental Protection Ho—flda Dept.of Transportation St.Johns River Water Management District k.—Y Corps of Engineers Division of Hotels and Restaurants Division of Alcoholic Beverages and Tobacco Cit�r: APPLICATION STATUS Reviewing Department First Review: E]Approved. DDenied. ��Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Ay— AT= Date: TREEADMIN. Second Review: DApproved as revised. E]Denied. E]Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date:— FIRE SERVICES Third Review: E]Approved as revised. DDenied. EDNot applicable Comments: Reviewed by: Date: Revised 05119120il'