1057 Beach Ave 07-00000764 Permit DocumentationCITY OF ATLANTIC BEACH
800 Seminole Road
Atlantic B
(904) 247•
(904) 247•
www.coat
APPLICATION TI
Property Address:
Applicant: e %i
Project: aa�. /t1A57�,2 dEIMaOrn
PERMIT
APPLICATION #
co
REQUIRED
PLANNING
BUILDING
PUBLIC WOFZK
PUBLIC UTILITIES
FIRE DEPT.
APPROVAL
Y
N
_
PLANNING
z
z
AGENCY:
N
BUIL NG
DATE:
Y
N
UBLI WOR
HUFSTETLER
0
YY
N
TILI S
❑
Y
N
FIRE DEPT.
CARPER
Y
N
PUBLIC SAFETY
co
CIRCLE ONE: SITE BUILDING DA AP REVIEWED BY: INITIAL: DATE:
PLANNING
BUILDING
PUBLIC WOFZK
PUBLIC UTILITIES
FIRE DEPT.
APPROVAL
0
IST
w
00
REQUIRED
AGENCY:
RECEIVED BY:
INITIAL:
DATE:
Z
Y N
D.E.P
HUFSTETLER
/ t3%
k �,s
PUBLIC SAFETY
0
❑
d
Y
S.J.R.W.M.
CARPER
MW
W w
Y
ARMY CORPS of ENG
CARPER
O
Y N
HOTELS & RESAURANTS
HUFSTETLER
APPLICATION STATUS
CIRCLE ONE: SITE BUILDING DA AP REVIEWED BY: INITIAL: DATE:
PLANNING
BUILDING
PUBLIC WOFZK
PUBLIC UTILITIES
FIRE DEPT.
0
IST
2ND REV
101P
/ t3%
k �,s
PUBLIC SAFETY
0
❑
3RD REV
®
0
Return this form to the Building Department once you have entered your comments into the AS400.
o. rr v
'SS
CITY OF ATLANTIC BEACH
;- 800 SENIINOLE ROAD
} ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
INSPECTION EMAIL REQUEST:
Building-dept(a,coab.us
Application Number . . . . . 07-00001003 Date 7/11/07
Property Address . . . . . . 1057 BEACH AVE
Application type description ELECTRIC ONLY
Property Zoning . . . . . . . RES GEN MULTI -FAMILY
Application valuation . . . . 0
----------------------------------------------------------------------------
Application desc
WIRE IN ROOM ADDITION
---------------------------------------------------- -----------------------
Owner
LOFF, HOWARD
1057 BEACH AVE
ATLANTIC BEACH FL 32233
Contractor
------------------------
LORE ELECTRICAL CONTRACTORS
210 N. ROSCOE BLVD
PONTE VEDRA BCH FL 32082
(904) 273-1143
----------------------------------------------------------------------------
Permit . . . . .
. ELECTRICAL
PERMIT
Additional desc .
.
Permit Fee . . .
. 70.00
Plan Check
Fee .00
Issue Date . . .
.
Valuation
. . . . 0
Expiration Date .
. 1/07/08
----------------------------------------------------------------------------
Fee summary
Charged
Paid Credited Due
------------------------------
-----------------
Permit Fee Total
----------
70.00
70.00
.00 .00
Plan Check Total
.00
.00
.00 .00
Grand Total
70.00
70.00
.00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
" CITY OF ATLANTIC BEACH
Y x ? ELECTRICAL PERMIT APPLICATION
Date: 7 - ( 7
Property Address: to 5 7
Owner: \.01 k Telephone #:
t
Contractor: !_d f'Q _- `e C��_ �-` _ Telephone #:
Contractor Address: 2 sFax #: S Z 3- 6rr(-4 7
Contractor Signature:
In consideration of permit given for doing the work as described in the above statement, we hereby agree to perform said work in
accordance with the attached plans and specifications which are a part hereof and in accordance with the City of Atlantic Beach
ordinance and standards of good practice listed therein.
Building:
❑ New
! Old
❑ Re -wire
Building Type: ❑ Trailer
❑ Residence ❑ Temp.
❑ Commercial ❑ Signs
❑ Addition Sq. Ft.
Service:
❑ New
❑ Increase
❑ Repair
If other construction is
being done on this building
Or site, list the building
Permit number
Conductor Size: AMPS: COPPER ALUMINUM
Switch or I
Breaker
AMPS
PH
W
VOLT
RACE
WAY
Existing Service
Size
AMPS 2Z�,
PH
-,
W
VOLT ri
RACE
WAY
Meter
Number
Feeders:
NO. SIZE
NO SIZE
NO SIZE
Lighting Outlets
CONCEALED
OPEN
-
Receptacles
CONCEALED
OPEN
U i
Switches
Incandescent
Fluorescent &
M.V.
Fixed
Appliances
0.100 AMPS
OVER
BELL
TRANSFER.
Air
Conditioning
H.P.RATING
COMP. MOTOR
H.P. RATING
OTHER MOTORS
AMPS
CEILING
HEAT
KW -HEAT
Motors
0-1 H.P.
VOLTAGE
PH NO.
I OVER I H.P.
PHS
Transformers
UNDER600V
OVER600V
NO.�... KVA
NO. KVA
No.Neon_Transf.
Ea. Sign
Miscellaneous
800 Seminole Road • Atlantic Beach} Florida 32233-5445
Phone: (904) 247-5800 • Fax: (904) 247-5845 • http•//www.ci.atiantic-beach.n.us
C " CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
INSPECTION EMAIL REQUEST:
Building-deptgcoab.us
Application Number . . . . . 07-00000764 Date 8/07/07
Property Address . . . . . . 1057 BEACH AVE
Application type description RESIDENTIAL ADDITION/ALTERATION
Property Zoning . . . . . . . RES GEN MULTI -FAMILY
Application valuation 150000
----------------------------------------------------------------------------
Application desc
2nd floor addition
----------------------------------------------------------------------------
Owner
Contractor
LOFF, HOWARD GENESIS BUILDING
1057 BEACH AVE 2158 MAYPORT RD.
ATLANTIC BEACH FL 32233 ATLANTIC BEACH
(904) 241-0320
-------------------------- Structure Information 000 000
Construction Type . . . . . TYPE 5-A
Occupancy Type . . . . . . RESIDENTIAL
Flood Zone . . . . . . . . ZONE X
CORP
FL 32233
----------------------------------------------------------------------------
Permit . . . . . . PLUMBING PERMIT
Additional desc INSTALL 4 FIXTURES
Sub Contractor SUNSHINE STATE PLUMBING
Permit Fee . . . . 63.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 2/03/08
----------------------------------------------------------------------------
Special Notes and Comments
*2004 FLROIDA BUILDING CODE W/105-106 SUPPLEMENTS.
2004 FLORIDA BUILDING CODE - RESIDENTIAL.
2005 NATIONAL ELECTRICAL CODE.
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
*EMAIL INSPECTION REQUESTS TO: BUILDING-DEPT@COAB.US
1) Provide impervious surface calculations. 2)Provide
erosion and sediment control plans with installation
details and maintenance schedule. 3) Provide plan for
parking and material delivery that does not block Beach
Avenue.
Fence must not interfere with function of on-site
stormwater storage area.
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total 63.00 63.00 .00 .00
CPlan Check Total .00 .00 .00 .00
PERMIT IS fAWE TSICIN ACCORDANCE WTfjj3ECLQ'tiITY OF AT&ATIi EACH ORDINANE&AND THE FLORIDR O
BUILDING CODES.
It j
r CITE' OF ATLANTIC BEACH
J Sj�
804 SEMINOLE ROAD
y ATLANTIC BEACH, FL 32233
� INSPECTION PHONE LINE 247-5826
f �J3 INSPECTION EMAIL REQUEST:
Building-degl@coab.us
Application Number . . . . . 07-00000764 Date 9/13/07
Property Address . . . . . .. 1057 BEACH AVE
Application type description RESIDENTIAL ADDITION/ALTERATION
Property Zoning . . . . . . . RES GEN MULTI -FAMILY
Application valuation . . . . 150000
-------------------------------------------------------
Application desc
2nd floor addition
--------------------------------------------------------------
Owner Contractor
-
------------------------
-----------------------
LOFF, HOWARD GENESIS BUILDING CORP
1057 BEACH AVE 2158 MAYPORT RD.
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 241-0320
--------------------------
Structure Information 000 000 -----------------
Construction Type . . . . . TYPE 5-A
Occupancy Type . . . . . . RESIDENTIAL
Flood Zone . . . . . . . . ZONE X
--------------------------------------------------------
Permit . . . . . . MECHANICAL PERMIT
Additional desc . .
Sub Contractor . . TROPIC HEATING & AIR
Permit Fee . . . . 51.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 3/11/08
------------------------------------------------------ -
Special Notes and Comments
*2004 FLROIDA BUILDING CODE W/105-106 SUPPLEMENTS.
2004 FLORIDA BUILDING CODE - RESIDENTIAL.
2005 NATIONAL ELECTRICAL CODE.
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
*EMAIL INSPECTION REQUESTS TO: BUILDING-DEPTQCOAB.US
1). Provide impervious surface calculations. 2)Provide
erosion and sediment control plans with installation
details and maintenance schedule. 3) Provide plan for
parking and material delivery that does not block Beach
Avenue.
Fence must not interfere with function of on-site
stormwater storage area.
-------------------------------------------------------------- --------
Fee summary Charged Paid Credited Due
Permit Fee Total 51.00 51.00 .00 .00
Plan Check Total .000 .00 .00 .00
PERMIT Is IT ACCORDANCE wi"t X&OCITY OF ATLUTIP %EACH ORDINANCAWAND THE FLORIDR 0
BUILDING CODES.
tItnIttry�.,, Q�',
BIDING / ZONING DtP NT
000 Seminole Road
Atlantic Beach, Florida 32233
(904)247-5800
(904)247-5845 Fax
www.coab.us
Property Address:
AppflIlcallflte
L�
L ,,t
PERMIT
APPLICATION #
w
REQUIRED
DEPT:
APPROVAL
Y
N
PLANNING
0
Y
N
BUILDING
I--
Y
N
PUBLIC WORKS
0
L.L.
Y
N
PUBLIC UTILITIES
Y N
Y
N
PUBLIC WORKS
PUBLIC UTILITIES
FIRE DEPT.
PUBLIC SAFETY
LU
N
�DEPT.Y
w
CIRCLE ONE: SITE BUILDING DA AP REVIEWED BY: INIAL: TE:
APPROVAL
®
1 ST REV
U ❑
UI ED
£Y
RECEIVED BY:
WI AL:
D
LU
Y N
D.E.
HUFSTETLER
2ND REV
d
� �
W
Y N
S.J.R.W.M.
CARPER
PUBLIC WORKS
PUBLIC UTILITIES
FIRE DEPT.
PUBLIC SAFETY
LU
Y N
ARMY CORPS of ENG
CARPER
O
Y N
HOTELS & RESAURANTS
HUFSTETLER
APPLICATION STATUS
CIRCLE ONE: SITE BUILDING DA AP REVIEWED BY: INIAL: TE:
®
®
1 ST REV
PLANNING
BUILDIN
®
®
2ND REV
PUBLIC WORKS
PUBLIC UTILITIES
FIRE DEPT.
PUBLIC SAFETY
®
®
3RD REV
Return this form t® the Buildine Department once you have entered your comments int® the AS400,
CITY OF ATLANTIC BEACH
1 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
wfif1:INSPECTION EMAIL REQUEST:
Building=depgcoab.us
Application Number . . . . . 07-00000764 Date 1/07/08
Property Address . . . . . . 1057 BEACH AVE
Application type description RESIDENTIAL ADDITION/ALTERATION
Property Zoning . . . . RES GEN MULTI -FAMILY
Application valuation . . . . 150000
----------------------------------------------------------------------------
Application desc
2nd floor addition
----------------------------------------------------------------------------
Owner
Contractor
------------------------ - ----------------------
LOFF, HOWARD GENESIS BUILDING CORP
1057 BEACH AVE 2158 MAYPORT RD.
ATLANTIC BEACH FL 32233 ATLANTIC BEACH FL 32233
(904) 241-0320
--------------------- Structure Information 000 000 ----------------------
Construction Type . . . . . TYPE 5-A
Occupancy Type . . . . . . RESIDENTIAL
Flood Zone . . . . . . . . ZONE X
----------------------------------------------------------------------------
Permit ELECTRICAL PERMIT
Additional desc . .
Permit Fee . . . . 70.00 Plan Check Fee .00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 7/05/08
----------------------------------------------------------------------------
Special Notes and Comments
*2004 FLROIDA BUILDING CODE W/105-106 SUPPLEMENTS.
2004 FLORIDA BUILDING CODE - RESIDENTIAL.
2005 NATIONAL ELECTRICAL CODE.
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
*EMAIL INSPECTION REQUESTS TO: BUILDING-DEPT@COAB.US
1) Provide impervious surface calculations. 2)Provide
erosion and sediment control plans with installation
details and maintenance schedule. 3) Provide plan for
parking and material delivery that does not block Beach
Avenue.
Fence must not interfere with function of on-site
stormwater storage area.
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
---------------------------------------------------------
Permit Fee Total
Plan Check Total
Grand Total
70.00 70.00
.00 .00
70.00 70.00
00 .00
00 .00
00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
rj dLf��r' CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD, ATLANTIC BEACH, FL 32233
r + OFFICE: (904)247-5826 • FAX NO.:(904)247-5845
J* BUILDING-DEPTQCOAB.US
ELECTRICAL PERMIT APPLICATION
DUVALCOUNTY
n'rt2ruGyVOJiuu,wa .. G iad ..21H7, >3�.atl.hndrx;,�'n �d "..i1'GI2.Bland'&�h.Il;dihlyal.,..hEP5.2 ,Z�ISTkIISASUB=;PERM{Tst�y{{a a as 7
i 51E nl bll ., 4-10":M!63' D%AT r 4I.M4 ,90
17. S VICE 9� 12d�(lllil dry "'' ¢I�' �CI� ffllF' 18:"METER NUMBER : m"� 2h���� d0, � . �1� � 020 '
11 NO
I'.�1'ES PERMIT#: [
Atlantic Beach FL 32233 U
n•• .. ., , «.. - 1 f° J;ii43 it �. k m t d r
i" y PROPERTY"OWNER
. a � ad, .. .
4. NAME:
5. ADDRESS IF DIFFERENT FROM JOB ADDRESS: 6. PHONE.
L p �
/ 0 S- � m cil
8101 ryd: L,iCONRACT A±c.1 :.3 GeG..yiet.�F.laen6e;'aCdr'.L.3 is d s`�a ias he a :;G9.ti,
r2t2?s: 4�".. ••}._
7. OF COMPANY: nB.
tz,Cr �c
6OR
ADDRES
&Y
9. STATE OF FLORIDA LICEN�SE1N� � �j /
/man` 3 �11 [_l0
10. CELL PHO QE: � ^ � � � .�
11. FAX NO
J-0.0 Y'6
12. EMAIL ADDRESS: , L Q 6
13. OFFICE PHONI � � r � � � �
14,
Ck
25. FEEDERS:
# OF AMPS: # OF AMPS: # OF AMPS:
7b. Application is hereby made to dlbtain a permit to do the work and installations as indicated. I certify that all work will be performed to meet
the standards of all laws regulating construction in this jurisdiction. This permit becomes null and void if work is not commenced within six (6)
months, or if construction or work is suspended or abandoned for a period of six (6) months at -anytime Vafterrcommenced.
CONTRACTORS SIGNATURE:
01 1,440 0F.. WORK: Gi«' 11. ax1:� �idl�rsitFiil4'. ix .; :e(�°�Y �y.�]h;�9��d1
17. S VICE 9� 12d�(lllil dry "'' ¢I�' �CI� ffllF' 18:"METER NUMBER : m"� 2h���� d0, � . �1� � 020 '
❑ MULTI FAMILY - # OF UNITS:
SINGLE FAMILY ❑ TEMP SERVICE
❑ ADDITION ❑ TRAILOR
❑ ALTERATION ❑ SIGN
❑ REPAIR ❑ POOL I SPA
&RESIDENTIAL
❑ COMMERCIAL
19? B 14DI�IG�$:IG��€},Iwlid,rr�xgl 7^CURRENT.CODEwlilldhldyl
OLD ❑ NEW ❑ '05 NATIONAL ELECTRICAL CODE
❑ REWIRE ❑ OTHER:
ia, - ky���rgl;,�ya +, d rtlL�m'I i�-•'i+4x•" 2P?g hP x","
.........! p?„1?dleI>: Ytl_ �.:mkkAl .�•]y'..5w.,.5.�.
° q+63 d3 "- P y F i�, �,;�:lkGyyyp`���,,, S
C..':�...,5g tlyf'a;Y n yrd'CE4
/At.L ELE(�'.j� (CA" WORK T-11119 �9n yuy9ppi y5.'��'�y.., ..__h� .....P 3 •1s?3 �;,rfiWP q,° y' :as; 81 :'
.sr.r.... ...,'+T•MxYa, +k,F.00,3e0 S „. :^n.. �G_,.i'9tlYiti!'g.��1��',Ir 8 uy�,�iABn"IYI.�' h=NC!�• n... •�Af$..,C,C
20. TYPE OF SERVICE:
❑ OVERHEAD UNDERGROUND ❑ UNDERGROUND UP POLE
21. NEW SERVICE:
CONDUCTORS PER PHASE: OWER IS ON ❑ POWER IS OFF
22. SIZE OF CONDUCTOR:
AMPICITY:_ ❑COPPER fa ALUMINUM
23. SWITCH OR BREAKER SIZE:
AMPS: PH: W: VOLT: RACEWAY SIZE:
24. EXISTING SERVICE SIZE:
AMPS: -k,)- PH: _L_ W: 3 VOLT: Z-40 RACEWAY SIZE: IOUC-
25. FEEDERS:
# OF AMPS: # OF AMPS: # OF AMPS:
26. LIGHTING FIXTURES:
INCANDESCENT: FLUORESCENT & M.V.:
27. FIXED APPLIANCES:
0-30 AMPS: 31-100 AMPS: OVER 100 AMPS:
28. FIRE ALARM:
❑ YES ❑ NO
IJV mil I,,rrL1 'W IYGYY JIIYV LC rF11Y1IL 1. n
29. SMOKE DETECTORS: NUMBER:
30. RECEPTACLES: 0-30 AMPS: 31-100 AMPS: OVER 100 AMPS:
31. SWITCHES: 0-30 AMPS: 31-100 AMPS: OVER 100 AMPS:
# OF UNITS. COMP. MOTOR HP RATING: AMPS: HEAT KW:
# OF UNITS: COMP. MOTOR HP RATING: AMPS: HEAT KW:
;G
,.- 3 S!31- e r :0-12'u
�riercd }
NUMBER: VOLTAGE: HP: KVA:
NUMBER: VOLTAGE: HP: KVA:
i as .<- .: 3. . SFORMERS N°.,,, t cl . , ,.t ';t { 2--4
.R
ldll.udll iI 9 ^. • ..ya,, a sa a. w.l r 4, TRAN. _. ,
UNDER 60OV: NUMBER: KVA:
OVER 60OV: NUMBER: KVA: �y
ayl 97 1 . Il p_'Ta � 9�91iQG'21aG;`?q r .`M1 hriY'�" � -s' `+, .. f" ll�e'ti�2'4�1? h�' 5! y,' .." , r x::35= MISCE AANEQUs, REPAIRS
i .. I 1 M' ! . r, AE° ..... SPY
DESCRIBE IN D,11Vn.� �
�r1�q &� z-<� n ��
COAG FORM BLDG02: REVISED: 8/13/2007
�`
I — -U)q
FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
-A Burewof Beaches and Coastal Systems
3966'Cornrnonwealth Blvd — MS 300
gg FLOR A Tallahassee, FL 32399-3000
'�8'50) 488-7708 No- qfPagvs A fiached.-
FIELD PERMIT PURSUANT TO SECTION 161.033 or 161.052, FLORIDA STATUTES
FINDINGS OF rAcr AND CONCLUSIONS OF LAW: The request for a permit was oonskierad by the staff designee of the Departrnent Of
Environnicrital Protection and found to be in compliance with the requirements of Chapter 6213-33, Florida Administrative Code (F.A.C.). Approval 6
spm1fically limited to the activity in the Asted,loation an
on the project description, Approved plans (if any), attached standard conditions, and any gpecW
conditions stated bck-)w pursuant to Parapaph 161.053(5), Florida Statulft. This permit may be suspended or revoked in accordance with Section 62-
4.100, F.A.C.
PROJECT LOCATION:
PROJECT DESCRIPTION,
SPECIAL Puma coNpnms: This permit is valid only after all applicable foderal, state, and low permits are obtained and does not suommize
contravention of local setback requirements or zoning or building codes. This permit and public notice shall be posted an the site imma&Wy upon
asuanx and shall remain posted along with local approval until the oomplebm or any activity udmzod by this permit Other spec el conditiom of this
Permit include:
STANDARD PXRMff CONDITIONS: The permittee shall comply with the suschW pbndwd field permit conditions,
APPLICANT INFORMATION: I hereby certify that I am either. (I a) the owner of the subject property 2t (I b) I have the owner's consent to same
this permit on the owner's behalf, and that (2) 1 shall obtain any applicable bcorwes or permits which may be required by federal, state, comty, or municipal
Mw prior to owmwwoment of the audwrized wok (3) 1 acknowle* that the authorized work a what I requested, and (4) 1 accept fes;moibility for
compliance with all permit cond".
Teicobone
Applicants Sirature Date—
Applicant's Printed Name
Addrew
ji
o
If applicant is in agentC
mmme ofprcp" QWMff
property o~o addmw prop" o"MW's fitlephone no.
DEPARTMENT FINAL ACTION AND FILING AND ACKNOWLEDGMENT: This field permit is approved an bob" of the Department of
Environmental Protection by the undersigned staff designee, and filed an this date, pursuant to section 120.52, F -S., vhffi the unders4ped desipated
Deputy Clerk, receipt of which is hereby w*nowledged.
SAO ty Ckv* P"i.,�'V~ qf
PUBLIC NOTICE IS ON THE 111ACK OF TILLS PERMIT. EXPIRATION DATE:
(Fmcrgencypermits issuedmiant to Section 6213-33.014, F.A.C., am valid for no more Own ninety days and otheiLM perinits arcvalid for no more
than 12 months. The staff designee may specify a oxxier time'limit)
EMnGENCY PERWT: 11 YES NO Approved plans we attached: 0M 0 NO
AND PUBLIC NOTICE CONSPICUOUSLY ON THE SITE
DEP form 73-122 (Updated 01/06) f7ideCopy-Tall&J�aaseeQfficej [YeUowCaFy-App1&camtj [Pmk Copy -S9qffDemg,,,,j
FLORIDA DEPARTMENT OF ENVIRONMENTAL PROTECTION
�ti y Bureau of Beaches and Coastal Systems
3900 Commonwealth Blvd — MS 300 Pow* Num6w.
FL A Tallahassee, FL 32399-3000
(850) 488-7708 No. ofPars Anached:
FIELD PERMIT PURSUANT TO SECTION 161.053 or 161.052, FLORIDA STATUTES
FINDINGS OF FACT AND CONCLUSIONS OF LAW: The request for a permit was considered by the staff designee of the Department of
F-rivionmental Protection and found to be in compliance with the roquirenterits of Chapter 62B-33, Florida Adrninidrdivc Code (F.A.C.). Approval is
specifically hrnAcd to the activity in the stated location and by the pro)ect description, approved plans (if any), attached standard conditions, and any qmcW
midifims stated below pursuant to Paragyaph 161.053(5), Florida Statutes. This permit may be suspended or revoked in accordance with Section 62.
4.100, FA.C.
PROJECT LOCATION:
PROJECT DESCRWrION:
SPECIAL PERMIT CONDITIONS: This limnit is Valid only after all applicable federal, date, and local perrnits we obbined and does W audKigim
contravention of local setback Taquvernentg of zoning or building codes. This permit and public nobot "ll be podbd an the m* triunedisidy Ww
issuance and Awn rennin posted along with local approval until the oompletion of any activity authorized by this pernut. Other Waco) conditions of this
permit include:
(A- Ai e' 6
A,
STANDARD pjZRmrr CONDITIONS: The permittee shall comply with the smochad suridard field paro conditions
APPLICANT INFORMATION: I hereby certify that I an other. (I&) the owner of the a6itct property gi (1b) I have the VWnVr'11 C01111011t 110 1111MM
this permit on the owner's behalt and that (2) 1 shall obtain any applicable Moons, or permits which may be sequired by federaL giat, cougity, or muni ipal
law prior to ammxioulwo of the authoroed worm (3) 1 wbwwk* that the &Wwrbzd work is what I mqucA4 and (4) 1 accept reVotisiWily for
compliance with all permit con it ons-
Dak
Applicant's S*Mkwm-
L. Addmn
Applicants Printed Nanic �J,
If applicant is an agent: ILI h LL�' '�,ApI pdroperry mmw propwey owwr's addmar properry owmw's Ackpimm no.
DEPARTMENT FINAL ACTION AND FILING AND ACKNOWLEDGMENT: Ilia fold pmnit is approved an behalf of the Department of
Environrrientod Protection by the undersigned staff designee, and filed on thin dab, pursuant to section 120.52, F.S., with the tindervigned dwignawl
De" Clark, raccipt of which is h=by acknowledged.
S ty Ckrk Prik*dName qfDejism&V*poqy Ciw* Dam,,'
PUBLIC NOTICE IS ON THE RACK OF THIS PERMIT. EXPULA71014 DATE-
(F,mergency permits issued pursuant to Section 62B-33.014, F-A.C., we valid for no more than ninety days and ;a—wzm Fc� wev'aW EFoo —n-som
than 12 months. The staff designee may specify a shorter tirne,lirnk)
EhMGE14CY PBZWT: 13 YES NO Approved plans arc attached: OM 13i4o
&ND PUBLIC NOTICE CONSPICUOUSLY ON THE SITE
DEP form 73-122 (Updated 01/06) VhaeCqp),-Ta11ahacxe0ffimj fYlow Cqpy-App1waaJ [P=kCqFy-S&ffDexXftj