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230 10th St FNCE19-0109 6' FENCE WALL OR BARRIER PERMIT PERMIT NUMBER CITY OF ATLANTIC BEACH FNCE19-0109 800 SEMINOLE ROAD ISSUED: 10/11/2019 V EXPIRES: 4/8/2020 ATLANTIC BEACH. FL 32233 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: 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. JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK: 230 10TH ST FENCE WALL OR BARRIER FENCE 6' FENCE $12000.00 TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION: CONSTRUCTION: NUMBER: GROUP: 170357 0000 ATLANTIC BEACH PARKWAY COMPANY: ADDRESS: CITY: STATE: ZIP: ARMSTRONG FENCE CO 3226 TALLEYRAND AVE JACKSONVILLE FL 32206 OWNER: ADDRESS: I CITY: STATE: ZIP: FRANCIS JAMES D 230 10TH ST ATLANTIC BEACH FL 32233-5750 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. 1 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL Notes: All runoff must remain on-site during construction. 2 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL Notes: Roll off container company must be on City approved list(Advanced Disposal,Realco Recycling,Shapells,Inc.,Republic Services,Donovan Dumpsters, Phillips Containers,JDog/Dennis Junk Removal,All American Roll Off,WCA Waste Corporation). Container cannot be placed on City right-of-way. Issued Date: 10/11/2019 1 of 2 FENCE WALL OR BARRIER PERMIT PERMIT NUMBER _. CITY OF ATLANTIC BEACH FNCE19-0109 800 SEMINOLE ROAD ISSUED: 10/11/2019 ATLANTIC BEACH. FL 32233 EXPIRES: 4/8/2020 I 3 r PUBLIC WORKS7 RIGHT OF WAY RESTORATION INFORMATIONAL Notes: Full right-of-way restoration,including sod,is required. 4 PUBLIC WORKS RUNOFF INFORMATIONAL Notes: 'All runoff must remain on-site. Cannot raise lot elevation. 5 PUBLIC WORKS FENCING REMOVED INFORMATIONAL Notes: All old fencing and debris must be removed from job site by Contractor. _.dam ,T.___ �FEE �2 . S DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT BUILDING PLAN CHECK 455-0000-322-1001 0 $17.50 FENCE 455-0000-322-1000 0 $35.00 PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 TOTAL: $81.50 Issued Date: 10/11/2019 2 of 2 �,i1,.Ly� City of Atlantic Beach APPLICATION NUMBER ,js' �� Building Department (To be assigned by the Building Department.) ;;_,s 800 Seminole Road F�QEJ Q Q v •I O Atlantic Beach, Florida 32233-5445 ` r Phone(904)247-5826 • Fax(904)247-5845 i A 011 ! E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: Z3drk— S+ Department review required Ye No Buildin Applicant: °(,p Cje_ fanning &Zoning ( tree i ra or Project: EK (Public Worizs– '��� lic Utilitie— Public Sae y 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. ❑Denied. ❑Not applicable (Circle one.) Comments: UILDI PLANNING &ZONING Reviewed by: / �� P.a7'! '/y i y Date: TREE ADMIN. Second Review: Approved as revised. ❑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 OFFICE COPY %'`„.='1% Building Permit Application Updated10/9/18 'r r, City of Atlantic Beach Building Department **ALL INFORMATION uK800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY on Lr IS REQUIRED. Phone: (904) 247--5882/6p Email: Building-Dept@coab.us h Q f /�, Job Address: /,30 frAn•--k L/ 1 I &C/I- Permit Number: F-1 v�1 { - Opt-c:,c Legal Description t-CTL 1 \4,--k,,Oc 7 i- Lc-ii-4 L e)f I j PL(� �tE# 0 F 7 ' �� lI � , Valuation of Work(Replacement Cost)$ (3-)00V, Or) Heated/Cooled SF Non-Heated/Cooled • Class of Work: XNew ❑Addition ❑Alteration ❑Repair ❑Move ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial ❑Residential • If an existing structure, is a fire sprinkler system installed?: ❑Yes ❑No • Will tree(s) be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) l 1No Describe in detail the type of work to be performed: 6 ! p11.� woos oo 41y1, Florida Product Approval# for multiple products use product approval form Property Owner Information Namejo1,Vt1A G&\. ' !)1,1.IVI.w ii(art 15 Address 1/.141 (-FP1v; 111,4 e, IVI.Z4,VLoV Dr ) VL * 3vz City , G kA O 4 V i i I c State IL Zip 32.Z07 Phone I 4o ak - 2 3 - 61-o I( E-Mail .51'11✓I.f !Ai h'6tVLL1S )(IAA1I d L.1,vv Owner or Agent(If Agent, Power of Attorneyjr Agency Letter Required) Contractor Information ,I Name of Company Arm -Fr 4 r q `-(,yl(,C C . Qualifying Agent lJ f II I Address 2)j)-Ls 'Irt I 1 C., /V .r\Jc1 ANC., City ill k-6or I ti c tate FL_. Zip '3 2 ZOL Office Phone q 04 " -39 L - 1333 Job Site Contact Number State Certification/Registration# E-Mail gkiq l 1%n) e LVWM Sh Y1.1 " (-c rit G . (-OWN Architect Name&Phone# J l Engineer's Name&Phone# Workers Compensation Insurer OR Exempt❑ Expiration Date Application is hereby made to obtain a permit to do the work and installations as indicated. I certify 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 all 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 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. W WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAZ cn rcit.b RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INT , VE z g 17- A_ TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE CL W o o u RECO DING YOUR N TICE OF COMMENCEMENT. 0 m p o • c 0 0 a 0 c /.Gi-l! . a ALj H `L Ca l (Signature of Owner or Agent) (Signature of Co ractor) 0 z CC Z ] � ODa `�` ned and sworn to(o affir'Q-.) befor�- --- this .ny of Signed and sworn to(or affirm before me this d N V '� ,rte � Z by I..!!1•�n�1IJ.1 ,.5 , , by W �::':PY<<<, TONIG':NDLESPERGE,,- _ i,S'1'. .r: Lot. . _r- (Signature of Notary) (] �. 0.W mill 5 r°' fi _ MY COMMISSION#EF 02"951 W I- Fr] C I - t-' Ek-,RES:October 6,2D:9 , w 0 U , ,_ �'lh I JobUnde � s [ lPersonal)Y Known OR W0 N uJ ] erso alv_ wL. ; cc U. [ ]Produced Identification C 9 p/'-7 [ I Produced Identification W 5 Type of Identification: r(ps Z--7 [ -59 - i -c ! -(Ype of Identification: Cr a Ar„.„ / .T Pivc6-/c/ ^ v/a9 OFFICE COPY NOTICE OF COMMENCEMENT State of E ` C• .., Tax Folio No. 1 7 03 S/ - 0 00 0 County of ET)l7kfCc.- 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,state in this NOTIC F l COLr MMENCEMENTy. Legal Description of property being improved: NT , E 0. r Ki-or,LA NTP-i-- Lo+ ZQ0'7 Lo -4 t7 f L 0 t [ k. t N-1 Address of property being improved: 13t TT VL-1 I1 5'�'V 66"{- A+1 G(vi h v CIU1/1, r1., General description of improvements: inh 1l (li 0 h J.(- Ike:.W (4 col[C h krtz.Z A i.;yOwner:JGVylCS a.,td �Y/Ly1/,.f4 Address: ��i11 �l`t'✓t �(tt� L 1�1t' ' Di' . 3O Owner's interest in site of the improvement: p �f (AY Jaz-Lsv✓t.vi f LE' I!_. 32207 Fee Simple Titleholder(if other than owner): Name: // Contractor: �Mh )Yo f'gt-t LDVVI 1' vt y — Address: . 2-1--&`,� G1 i if Y re( vt 61 We/ r f Telephone No.: '1 D',"t' �%�/, - 2-3 j3 Fax No: Surety(if any) Address: Amount of Bond$ Telephone 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: Telephone 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 713.06(2)(b), Florida Statues. (Fill in at Owner's option) Name: — Address: Telephone No: Fax No: Expiration date of Notice of Commencement(the expiration date is one (1)year from ,f1,, ppf recquijn y ?eEdiffere t date is specified): 2 ' __ MYCOMMISSION#FF924951 J,!.-*:,; EX.P!RE3:October;,zu,a ` ' Branded Thor,otury Public Urderwriters THIS SPACE FOR RECORDER'S USE ONLY OWNER !: - Doc#2019196767,OR BK 18908 Page 1740, Signed: 5-1-4.-44 tA-1 ''� � , -- " Date: :7;0)2"41 qNumber Pages: 1 Before me thida o III. IIP in the FountyoptDuval,State Recorded 08/22/2019 03:42 PM, .'Mrs 1=t'c<i.cc S RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL Of Florida,has personally app ed ,,,71 e _� COUNTY Notary Public at Lar o lorida,Coui•f► al. RECORDING $10.00 My commission expires: Personally Known: or Produced Identification: FC:2 5 Z-7 ci CI - S9 —9 4 ` O _ c_L©( ', G , rv'd l E. p GI--,e „ OFFICE COPY Owner Builder Affidavit **ALL INFORMATION rS !/�� HIGHLIGHTED IN City of Atlantic Beach Building Department GRAY IS REQUIRED. , fl - 800 Seminole Rd, Atlantic Beach, FL 32233 "tj''` 247-5826 Email: Buildin -Det coab.us PERMIT /LLE --(4/O Phone: (904) � p @ � �y I. FLORIDA STATUTES;CHAPTER 489, FLORIDA STATUTES, PART 1 "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. YOU HAVE APPLIED 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 REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING ORDINANCES. II. INJURY LIABILITY;SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE PURCHASED. . III. 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(1). 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-DEPT@COAB.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. Job Address: 2.3U 'T-tAAA1A 1"/GG .frtia.,,1 k , bcAbk Owner Name:J 4v \1'4 LL U D IAI ✓({x,1( Want 's Phone Number: 14014 - CIL 3 -6 go' Mailing Address: )31I t'(,Vt �A (, M tL .OII G. City: J6t,(,Ir- 0 Ail iLx G State: I'(, Zip: 3 . Ji ) 7 4 30i Notarized Signature of Owner--' .,,/,,y i,1. d The-fgregoing instrument was acknowledged before me this Z Z_day of_ 0 ,2019 in the State of Florida, County of ( )0Vo "4 Signature of Notary Public • lb.. [ ] Personally Known OR [ ] Produced Identification Type of Identification: LI ,. Y -' =��� Updated 10/24/18 ,, -1.'7,f.'2_-_ ___—_—„,___ TONI C,INDLESPE. '2.t `'''- :'`'':. M`(COMMISSION#FF 924951 .'_ .--';',_-_,:z?-,,' EX?!RE5:October 6,2019 Iinnded Tnm Notary Public Underrinters OFFICE COPY 10th STREET (40'RIGHT-OF-WAY) 19' WIDE PERVIOUS PAVER i 3'PERVIOUS DRIVEWAY W/36" PAVER GRAVEL BEDS WALKWAY 1500 . P" n"e N 83'11'I1"Era o _ ? 1 GE. - 5.16' 12.1 C. I - 9 10.IT I 7l nrr- 124 n � 4• r— FENCE W/ - r, I GATE \ '•� _` L ?, -' t 'f �r 14' r r 14' 25.15' 1 65' W RAVEL 3 is i EXISTING FENCE W/ 7n '`_.= STRUCTURE W GATE v 1..^0 0 r co TO BE v k.— a r- r REMOVED v PERVIOUS PAVER ,a l-;. 0 0 ----1 v SIDE STOOP z I Zt OUTSIDE F ,`� .*.‘• '� T `« t!1 in SHOWER 125 �°` �, FIN FLR 125in Q *�4 0 �'1s. • 14.4 4 / W 1 .,.6t) pp,..'�` I I 111 205' 12.4 I pPx;n sqlA'[ ) 2133' �� "?#20'00,61 "P t,t4.1,-Qlig ., o n' I ��� 1/ , • ►�« r5.16' Pi l' \A"? I .0.\16. 9 P„r I FENCE- IA"12.615.00 S 53.1111"W s 04 13ID FOOL 4 DECK (PERVIOUS PAVERS) BY OTHERS (NOT A FART OF THESE FLANS) 1TEEE SG••IWULE LOT COVERAGE: LOT 1,125 SQ FT STRUCTURE COVERAGE 3,303 SQ FT n'f EXISTING TREE TO REMAIN STRUCTURE 3,303/1,125 •46.4% PERVIOUS PAVER DRIVE (50%CREDIT) P W/GRAVEL BEDS 141 SQ FT ,�« EXISTMG TREE PERVIOUS WALKWAY 4, TO BE REMOVED (50%CREDIT) 26 SQ FT PERVIOUS PAVER SIDE STOOP LVO LIVE OAK (50%CREDIT) S SQ FT CED CEDAR A/C PADS 0 SQ FT PALM PALM PERVIOUS PAVER HOL HOLLY POOL DECK(AT 50%) 32 SQ FT RAI RAINTREE MUL MULBERRY TOTAL IMPERVIOUS 3,534 SQ FT OWE CHERRY IMPERVIOUS COYER4GE 3,534/1,125 •49k% PREPARED FOR: illGLENN LAYTON 1-40MES SCALE LOT 18 4 THE EAST KI,�YBOR 8ociates, inc. 1"...20'-0" 21.61' OF LOT 17, BLOCK 1 I2i'aBIDENTIAI, DESIGNE128 pm DRAWN BY ATLANTIC BEACH PARKWAY u/30/2018 JeF 230 10th STREET 1999 Wells Road •Suite E • Orange Park, FL 32073 JOB NO. PLAN N0. ATLANTIC BEACH, FL 32233 Tel: (904) 272-5339 18-1051 K1631 PLAT BOOK 15 PG. 61 City of Atlantic Beach - APPLICATION NUMBER ( jsJ , . !M WR A....Building Department (To be assigned by the Building Department.) 800 Seminole Road c,., AUG 2 6 2019 Ft CFJ 9 - •tI o9 Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)2 845 v41.ti:�0;1tq: E-mail: building-dept@coab.us BY_ Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: Z3 O I V--t- De artment review required Yes No Buildin Applicant: 0 M C, '_ lanning &Zoning Treeminis ra or Project: �p (-l- lic Works—, 1PTblic Utilitie— Public SaT 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. ❑Denied. nNot applicable (Circle one.) Comments: BUILDING PLANNING &ZONING •. Reviewed by' ,,,� / I .te: 7--.1.---- TREE ADMIN. Second Review: ❑Approved as revised. ❑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 rs�y‘, -, City of Atlantic Beach APPLICATION NUMBER �S . � Building Department (To be assigned by the Building Department.) J 800 Seminole Road �`�Cil t;] - I OQ s' Atlantic Beach, Florida 32233-5445 I C` ` f Phone(904)247-5826 • Fax(904)247-5845 `• 9;i ty,' E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: -z3 0 ` Q S+ Department review required Yes No Buildin Applicant: CD l,0 N C - fanning &Zoning Tree Aaministrafor Project: CO is n ,.(Pf61ic Utilities Public Safey 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: pproved. I (Denied. I (Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONINGe"2 6— 19 Reviewed by: Date: TREE ADMIN. Second Review: Approved as revised. ❑Denied. I INot 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 „:/!...:-\,,i-,--4,,‘ City of Atlantic Beach APPLICATION NUMBER �S � Building Department (To be assigned by the Building Department.) i tla SeminolecRoad j`�CE, C1 - •I O9 Atlantic Beach, Florida 32233-5445 ` '"� Phone(904)247-5826 - Fax(904)247-5845Q 4. `. >'' E-mail: building-dept@coab.us Date routed: V City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM ....,t__ Property Address: z3 O I i” S Department review required Yes No cBuildin Applicant: 0 LAD fanning &Zonings ( Tree minis ra or Project: � r- •lic Work- lic Utilities Public Sa ety 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. Denied. I Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING ' K� 1—2 7—/ 9 Reviewed by: ate: TREE ADMIN. Second Review: Approved as revise . ❑Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: I (Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017