2314 Barefoot Trace ACC19-0023 Deck ACCESSORY PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH ACC19-0023
800 SEMINOLE ROAD ISSUED:4/11/2019
ATLANTIC BEACH. FIL 32233 EXPIRES: 10/8/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
[NOTICE: 11,n add.,tion to the requirements of this permit,there may be additional restrictions applicable to this property
OT a ho It
t t may fo,
hat may be found in the public records of this county,and there may be additional permits required from other
g R.:
.m. m.I tric.
overnmental entities such as water management districts,state agencies,or federal agencies.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
2314 BAREFOOT TRACE ACCESSORY SINGLE OR TWO
FAMILY ACCESSORY WOOD DECK 55000.00
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1694630602 OCEANWALK UNIT 02
COMPANY: ADDRESS: CITY: STATE: ZIP:
CLAUSEN KEITH E 2314 BAREFOOTTRCE ATLANTIC BEACH FL 32233-6603
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR 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,
LIST OF CONDITIONS
Roll off container company must be on City approved list. Container cannot be placed on City right-of-way.
PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
qw-1
.A.MilLiust remain on-site during construction.
2 PUBLIC WORKS ROLL OFF CONTAMER IATIONAL
nust he on City approved list(Adlvanc�d Disposal,Realco Recycling,Shapells,Inc.,Republic Services,Donovan Clumpsters,
runis Junk Removal,All American Roll off,WCA Waste Corporation). Container cannot be placed on City right-of way.
Issued Date:4/11/2019 1 of 2
ACCESSORY PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH ACC19-0023
ISSUED:4/11/2019
a-- 800 SEMINOLE ROAD EXPIRES: 10/8/2019
t ATLANTIC BEACH. FL 32233
3 PUBUCWORKS RIGHT OF WAY RESTORATION ATIONAL
4 PUBLICWORKS DOCO M E NT I M PERVIO U S AREA INFORMATIONAL
Gay,
Strongly suggest thorough documentation of impemious areas be recorded.
5 PUBLIC WORKS DECKING REMOVED INFORMATIONAL
Notes:
All old decking must be remowd from job site by Contractor.
DESCRIPTION ACCOUNT QUANTITY PAID AM
BUILDING PERMIT 455-0000,322-1000 0 $80,00
BUILDING PLAIN CHECK 455-00(0-322-1001 0 S4ODO
PW REVIEW BUILDING MOD OR ROW 001U0000-329-1004 0 $25.00
STATEDBP�SURCHARGE 455ROOOOK208�700 0 $2.00
STATE BEA SURCHARGE 455-00DO-208-0500 0 $Z.W
ZONING REVIEW SING�AND��O FAMILY�USB 0�1�32B-Iddri 0 S50.w
TOTAL:$199.00
Issued Date:4/11/2019 2 of 2
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be amigned by the Building Department.)
800 Seminole Road
Atlantic Beach, Florida 32233�5445
Phone(904)247-5826 Fax(904)247-5845
E-mail: building-dept@coab.us Date routed:
City�eb-site: hitip/1�.coalb.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: -Z�>( 4 e)cLre-"-[ Ir- Department review required Yes No
('me!
Applicant: ————————— oran?i-�,
Tree Administrator
Project: oo,,�'
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 RiverWater Management District
Any Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: lvwproved. E]Denied. E]Not applicable
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed IaA� Date:!1-3—m
TREE ADMIN. Second Review: E]Approved as revised. E]Denled. E]Not applicable
PUBLICWORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:—
FIRE SERVICES Third Review: ElApproved as revised, ElDenied. E]Not applicable
Comments:
Reviewed by: Date:—
Revise,10511912017
City of Atlantic Beach niECFF1Vr_ APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
800 Seminole Road . � APR 0 12019 C)z 3
Atlantic Beach, Florida 32233-544 0
Phone(904)247-5826 Fax(904)4_5845
E-mail: building-dept@coab.us - ---------- Date muted: !q
City web-site: http:/1wwwcoab�us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 2:�)( 4 P)are4�of —1f- Department review required Yes No
Applicant: L':)A:�>&R— nning&Zoninj�)
i ree Administrator
Project: 0 0 i��
4�2�_ Utl I'll.
Review fee Dept Signature
Other Agency Review or Permit Required Review
of PenmIt=PBy Date
Flonda Dept of Envirornmental Protection
Florida Dept.of Transportation
St.Johns Rwr Water Management Distinct
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: [/Approved. ElDenied. []Not applicable
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed Date:
TREEADMIN. Second Review: E]Approved as revised. E]Denied. F]Not applicable f
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:—
FIRE SERVICES Third Review: E]Approved as revised. E]Denied. F]Not applicable
Comments:
Reviewed by: Date
R.vm.d!0511912017
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department I
800 Seminole Road
Atlantic Beach, Florida 32233-5445 oo z
Phone(904)247-5826 I'm(904)247-5945
E-rnall: building-dept@coab.m Date muted: 44
City,velb-site: http:/&vmv.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: -Z�>J4 6 O_r e-'"+ I f- Department review required Yes No
Applicant: --------— onu-nb
Tree Administrator
Project: b`lkl) 00i�:) IF-Q-K
��bl,,c Sail.e:
Review fee $ Dept Signature
Other Agency Review or Permit Required Review I Date
Florida Dept of Environmental Protection of Pemnit=y
Flonda Dept.of Transportation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: ORApproved. E]Denied. []Not applicable
(Circle one.) Comments:
(HD:l�NG)
PLANNING&ZONING Reviewed by: Date: 9
TREEADMIN. Second Review: E]Approved as revised. E]Denqd. E]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date
FIRE SERVICES Third Review: E]Approved as revised. E]Denied. E]Not applicable
Comments:
Reviewed by: Date:
Remleed 0511912017
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned bythe Building Department.)
BOB Seminole Road
Atlantic Beach,Florida 32233-5445 3
Phone(904)247-5826 Fax(904)247-5845
E-mail: building-dept@coab us Date muted:
City web-site Ii//www coalb us
APPLICATION REVIEW AND TRACKING FORM
Property Address: -Za>14 &pe_-[O0+ If- Department review required Yes No
u
�R�ning&Zori
Applicant: OL�(�De-R— Tree Administrator
Project: bu 0 0 i:�) C"�
X-Pub4QUi
T�11 tcSalely
.S.,c.;
Review fee $_ Dept Signature
Other Agency Review or Permit Required Revlaw or'R 'P
f Pe dint V r 000 Date
0 f,.d By
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management Distinct
jinny Corps of Engineers
Divisio,of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: E]Approved. ElDenied. MNt applicable
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed byNef::� t
TREE ADMIN. Second Review: E]Approved as revised. E]Denied. F]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: [:]Approved as revised. E]Denled. EINot applicable
Comments:
Reviewed by: Date:
Revised 064912017
AgkiL Building Permit Application updw�d 1019118
City of Atlantic Beach Building Department '*ALL INFORMATION
800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
Phone: (904) 247-5826 Email: Building-Dept0cciab.us IS REQUIRED.
JobAddress: Z3j!j liflo-i hc 111!A c L� Permit Number: bh &�s
Legal Description 14 1.-1� 0 S -1.5-'L9 6 3 1 -7,5-q F OCSUA�Al k OA+7. RE# 12 LOCtqb5-(XO-L
Valuation of Work(Replacement Cost)$ :�4cqoo Heated/Cooled SIF "t-5-0
-Non-Heated/Cooled_
• Class ofWork: ONew. DAddition DAlteration 01repair C]Move dDemo OPool DWinclow/Door
• Use of existing/proposed structure(s): OCommerclat RGsidential
• If an existing structure,is a fire sprinkler system Installed?: [1yes 0%ro
• Will treptsi he removed in association with woposed prolect�E]Yes(must submit separate Tree Remo -j
[Describe I.detail the type of work to be performed: Our- k,�c It. A-ec le. ij r o fil� eedi IV b A �ee.
We- j9k-1 I $ jit 4j w4 �)441 A e x C_ ��k,,qjj
C-)C-o l< (V\, Py 5JL 1-1/ 1
Florida Product Approval# C) for multiple products use product approval form
Property Owner Information
Name kiz4t� Ct��Je � --Address ZYJ a M-e tv.i- -ryt C e
City-d±j.��4, i5eqck state F L. zip jZ7-Jj Phone 904 -60-7-6141
E-Mail k C-i"V Se..)&L A*e-VIlle,Hcjq 15 h d e7,f—, e. �i
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Information
NameofCompany QuallfVin nt
Address CRY ��State Zip
Office Phone
���JobSft�aC a�
ct Number
State Certificatlon/Registration If E-Ma'
Architect Na me&P hone# OR�Exempt 0 �Expllltwn Date�
Engineer's Name&Phone If
Workers Compensation Insurer OR Exempt 13 Expiration Date-
Application Is hereby made to obtain a permit to do the work and Installations as indicated.I certffY that no work or installation has
commenced prior to the issuance of a permit and that all work will be performed to meet the standards of al I the laws regulating
construction In this jurisdiction,I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS,
WELLS,POOLS,FURNACES, BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE:In addition to the requirements of this
permit,there maybe additional restrictions applicable to this property that maybe found In the public records of this county,and
there maybe 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
RECDR��
'4��ICE OF COMMENCEMENT.
(Signature of Owner or Agent) (Signature of ractor)
nedl and sworn to(or aff"me before ma this7-9 day of Signed and sworn to(or affir d)before me this_day of
TONI GIN)LES - (slaninur.of Nouiry)
Myc0vMiS8IN# 51
FXPRES:0aitor 6,019
-r '1'
I j Personally Known OR
Produced Identification Produced Identification
Type of Identification: C4 Z-6-So G-(07-00e)1-3�pe of Identification:
-_____..Prudent in I jr DO 2
Ju.25 2002 1 : 10PM Kurstar ConstructiGn inc, o 1655.p.
LOT 50, 'KAt- -'�Huvvfilliu BOUNDARY SURVEY OF.
13 THROUGH OCEANWALK UNFr WO, AS RECORDED IN PLAT eOOK 42, PAGES
13D OF THE CURRENT PUaWC RECORDS OF DUVAL COLINT)r, FwRim
kfjA4,)U('k W ka r,
LOT B1
e �e,,q
SM34'16"E 157 90'
r—, Ertl".11,
w
LLJ o
w
1-c
z
P;o
0
N81'34'16V 150.7 7' vv�
LOT 49
CER]IFIM M,
KLIIH E. & JUDY A. O�W�
Our" GROUP. INC.
IT "
HOE ljr� MILL IMURANCE OF NF1, YOAK
ROBER7 A. IITrRN
elm I--i-R
lltU I- 1L.1U
mmICm
-�.JIM
—X MbW
NOT YMO M—,� T M 11iflOillin W III,W IN, B—16,33
ALL INFORMATION
Owner Builder Affidavit JOB COPY **HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Depti?tkoab.us PERMIT#: A61
1. FLORIDA STATUTES;CHAPTER 489, FLORIDA STATUTES, PART I"CONSTRUCTION CONTRACTING'REQUIRES
OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED CONTRACTORS. YOUHAVEAPPLIED
FOR A PERMIT UNDER AN EXEMPTION TO THAT LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER
OF YOUR PROPERTY,TO ACT AS YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A
LICENSE.
YOU MUST SUPERVISE THE CONSTRUCTION YOURSELF.
YOU MAY BUILD OR IMPROVE A ONE OR TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY
ALSO BUILD OR IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS.
THE BUILDING MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR AFTER THE
CONSTRUCTION IS COMPLETE,THE LAW WILL PRESUME THAT YOU BUILT IT FOR SALE OR LEASE,WHICH
IS IN VIOLATION OF THIS EXEMPTION.
YOU MAY NOT HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR.YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS.
IT IS YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE LICENSES
I BEIOUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES
Aill"ANI I
H. INJURY LIABILITY;SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT
SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. .
Ill. IRS WITHHOLDING;OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO OBSERVE IRS WITHHOLDING
TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY;UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES.OWNERS BEING SUBJECT
TO$5,000 PENALTY UNDER FLORIDA STATUTE NO.455-228(l). AN-OCCUPATIONAL LICENSE' IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY'CERTIFICATE OF COMPETENCY'OR THE FLORIDA"CONTRACTORS
CERTIFICATE"TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT(904-
247-5826 OR BUILDING-DEPTODCOA&US)IF IN DOUBT.
V. ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE STATEMENT AND THAT I
COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN OWNER-BUILDER PERMIT.
JobAddress: 13iq Gare+-vi -r�(e yffleAbc &eqoL 974� 3ZZ �3
OwnerName: ke,iHn Cj.�Se� -PhoneNumber: 901J-bO7—b/!V3
MailingAddress: 7_3)q _6�,1e4.j r�re City: 141411 e%4 State: zip: 3-27- 79
Notarized Signature of Owner
Th oreyoilng i�strument was acknowledged before me thls.L�dfol�a�Oj3n the State of Florida, County
of Signature of Notary Pubilyz gcl��
[ ] Personally Known OR ] Produced Identification
Type of Identification:
MNI GIMILESPERGER
MYC0MMISSM#FFW4951 Updated 10124118
1 EXPIRES 0&b.r 6 2019
wdedTtwl%'�IPub�U�d
JOB COPY
OCEANWALK ASSOCIATION, INC.
Request for Architectural Review for Alteration or Additions
The ARC Committee meets the 2ndMonday of every month. ARC Requests and documentation
must be received by the ARC Chair I weekprior(on Ist Monday)for delivery to the ARC
Committee.
1. OWNER'SNAME: Ke';41 CLUIe'l EMAIL: j<C_1oL-1je,) &1�koiqhtmol
2. ADDRESS FOR ARC REQUEST: 7-S) q got r cf-o,?L 7-,�
3. OWNER'S MAILING ADDRESS IF DIFFERENT:
4. PHONEHOME: '10q-607-611�� CELL: ?oq-607- 61'13
5. DESCRIPTION OF THE PROPOSED ALTERATION OR ADDITIONS:
R,tplmce roi4c� back, decL) re'bV11d- C4-t 14 L';cLj
Lyfic� 5ct� p f a /I a,-e ss u y-e +y-eA 0
6. CONSTRUCTION MATERIALS, STYLE, SIZE,AND COLOR:
a) Material#1 style,size,color: F" J"t 1-�Aea �-e-(,LkAq Sample included
b) Material#2 style,gin,color: fftfj�v-t '�"Itl Sample included
c) Material#3 style,size,color: I"it a Iv- J?Y� Saniple included
7. PLAN DRAWING BEFORE AND AFTER CHANGES ON PLAT REQUIRED,
ATTACHED: El YES D'NO
8. CHANGES TO LANDSCAPING OR DRAINAGE: DYES 2<0
-If YES, include a descr4tvlon of the changes and show on Plan DrawinglPlat.
9. PICTURES AND/OR MANUFACTURER'S LITERATURE:
nPictures F1 Manufacturer's Literature
10. AMOUNT O��E REQUESTED TO COMPLETE PROPOSED PROJECT:
0 30 days Vj 0 days 0 90 days 0 120 days 0 180 days 0 Other
11. IS A PERMET FROM CITY OF ATLANTIC BEACH REQUIRED: ZYEsE]NO
(If required submit copy to ARC Chair when approved)
11 Page / March 2019
12. WILL TREES BE REMOVED: YES d NO F Arborist Letter Attached
Tree Removal requires ARC approval first with a letter from an Arborist. City of Atlantic Beach
requires approval as well. ***Cutting down trees WITHOUT PRIOR APPROVAL will result
in firies from HOA and City of Atlantic Beach.***
13. CONTRACTOR/VENDOR INFORMATION:
Company Name: owle'v—
Address:
License Number: Permit Number:
Only the PROPERTY OWNER as listed on the title to the property may request any
architectural changes. If a contractor is hired it is the owner's responsibility to be am they
have proper insurance and licensing for the work being done. It is also the owner's responsibility
to ensure permits are obtained through the City of Atlantic Beach prior to starting work and for
forwarding final inspection report to the association upon completion.
14. CERTIFICATION: (Please read and check each box below)
I understand the tofto
0 The proposed alteration submitted for approval does not violate any Duval or City of
>dantic Beach codes.
EJI am required to.comply with all Duval or City of Atlantic Beach construction and/or
dnovation requirements.
�No construction or exterior alteration undertaken by me or on by behalf before approval of
this application is allowed. If alteration are made, I may be required to return the property
to its former condition at my own expense if this application is disapproved wholly or in
'part, and that I may be required to pay all legal expenses incurred.
Members of the Oceanwalk ARC Committee or HOA Board are permitted to enter upon my
property at my reasonable time for the purpose of inspecting the proposed project,the
-/project in process, and the completed project,and that such does not constitute a trespass.
Approval is contingent upon construction or alterations being amide in a professional
[]]4anne
The alority granted by this application will be revoked automatically if the project has not
been completed within the 180 days of the approval date of this application or as specified
by the ARC.
21 Page / March 2019
df any alteration on property creates an adverse drainage impact to the lot and/or any
Ifs,
adjacent property, I may be required to modify my property, at my own expense, to correct
the dramage impact.
I c"ertz the foflawin :
[Z/NC thing(e.g., equipment,deck, fence, addition,planting,tree, landscaping or other
/n impmvement)is/will be installed beyond my property line and that no part of the requested
o
0] alterations will encroach onto Oceanwalk Common spaces.
�l havne read and understand the appropriate sections of the Oceanwalk Articles of
Incorporation, Covenants and Restrictions,By-Laws and Rules and Regulations that pertain
to this applicati and my proposed project.
/%77 3 1 7,ct [ I
SIGNATURE OF THE PROPERTY HOMEOWNER DATE
Any incomplete application will be returned for clarification and/or completion.
Please note this approval Is for architectural review purposes only! This approval does not
overrule any Federal, State or Local governing agencies,regulations,permits requirements,etc.
It is the responsibility of the property owner to obtain and comply with such. The Association is
released from all boundary line disputes. The owner is responsible for obtaining their survey to
confirm lot lines and easements PRIOR to starting any work.
FOR ARCHITECTURAL REVIEW USE ONLY-DO NOT WRITE IN THIS AREA
RECEIVED COMIPLETED REQUEST:
DATE SENT BACK TO HOMEOWNER IF NOT COMPLETE:
APPROVED DATE: YES F� NOF-1
REASON FOR DISAPPROVAL:
FINAL INSPECTION DATE:
DID IT COMPLY WITH REQUEST: YES NO F1
IF NO,WHAT CORRECTIVE ACTION TAKEN:
31 Page /March 2019