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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