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654 Aquatic Dr FNCE19-0127 6' S' 'L'r FENCE WALL OR BARRIER PERMIT PERMIT NUMBER ' 1 FNCE19-0127 CITY OF ATLANTIC BEACH ISSUED: 11/8/2019 800 SEMINOLE ROAD EXPIRES: 5/6/2020 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: 654 AQUATIC DR FENCE WALL OR BARRIER FENCE install 6-ft. fence $2200.00 TYPE OF REAL ESTATE ? ZONING: BUILDING USE SUBDIVISION: CONSTRUCTION: NUMBER: GROUP: 171818 5218 AQUATIC GARDENS COMPANY: ADDRESS: CITY: STATE: ZIP: Big Jerry's Fencing 12620 Beach Boulevard #3-131 Jacksonville FL 32246 OWNER: ADDRESS: CITY: STATE: ZIP: DRABKIN KONSTANTIN 4317 CASCADE ST ENID OK 73703 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: 11/8/2019 1 of 2 .,„:s''''rjr FENCE WALL OR BARRIER PERMIT PERMIT NUMBER t." ,„.. .„.. 0., CITY OF ATLANTIC BEACH FNCE19-0127 xio\V� 800 SEMINOLE ROAD ISSUED: 11/8/2019 �`cm AATLANTIC BEACH. FL 32233 EXPIRES: 5/6/2020 I 3 PUBLIC WORKS 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. 6 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL Notes: Any damage done to infrastructure must be repaired by Contractor. FEES 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: 11/8/2019 2 of 2 rt,"�'�r�.• City of Atlantic Beach APPLICATION NUMBER 1/0' „' Building Department (To be assigned by the Building Department.) 800 Seminole Road �` �J ! �,� o � Atlantic Beach, Florida 32233-5445 (- /” (� `l yr) Phone(904)247-5826 • Fax(904)247-5845 Ia-I.L (C•_ E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: CODepartment review required Ye No .Idi Applicant: �1 1 L Ly l� iK_�'�� Planning &Zonin `1 (� Tree Administrator Project: el ( k lo`_ h �-4nci �P Public Utilities) Public Safety 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: [VA�pproved. ❑Denied. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: /O •2 2-D-019 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. INot applicable Comments: Reviewed by: Date: Revised 05/19/2017 OFFICE COPY ,. Building Permit Application Updated 10/9/18 "-City of Atlantic Beach Building Department **ALL INFORMATION ..<)), 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY -,,c% IS REQUIRED. Phone: (904) 247-5826 Email: Building-Dept@coab.us Job Address: 654 Aquatic Dr,Atlantic Beach,FL 32233 Permit Number: Fr) CEI 9 ~0 (A Legal Description 6'tall stick built stockade fencing RE# Valuation of Work(Replacement Cost)$2200 Heated/Cooled SF Non-Heated/Cooledpp • Class of Work: iZlNew ❑Addition DAlteration ❑Repair ❑Move (=Memo DPool ❑Window/P °°""�� I\IE • Use of existing/proposed structure(s): DCommercial 1Residential • If an existing structure,is a fire sprinkler system installed?: ❑Yes 6dNo • Will tree(s)be removed in association with proposed project?DYes(must submit separate Tree Removal Perrrer' 1N$ A 2019 Describe in detail the type of work to be performed: 6' tall stick built stockade fence as marked on survey Building Dept) tment Florida Product Approval# for multiple products ustl��i��yy IgdT4fAtIr I ffte Beach, FL Property Owner Information Name Maria Drabkin Address 654 Aquatic Dr City Atlantic Beach State FL Zip 32233 Phone (850)382-7696 E-mail mariadrabkin@gmail.com Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) Contractor Information Name of Company Big Jerry's Fencing Qualifying Agent Address 12620 Beach Blvd,Ste 3-131 City Jacksonville State FL Zip 32246 Office Phone 904-476-2528 Job Site Contact Number State Certification/Registration If N/A E-Mail jon@bigjerrysfencing.com Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Insurer OR Exempt la Expiration Date 2114/20 a. Application is hereby made to obtain a permit to do the work and installations as indicated.I certify that no work or installation has 0 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, t WELLS,POOLS,FURNACES, BOILERS,HEATERS,TANKS,and AIR CONDITIONERS,etc. NOTICE:In addition to the requirements of Ws N permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,ar. N there may be additional permits required from other governmental entities such as water management districts,state agencies,, J fa federal agencies. J 0Z O OWNER'S AFFIDAVIT:I certify that all the foregoing information is accurate and that all work will be done in compliance with all n' Co I= applicable laws regulating construction and zoning. O H WARNING TO OWNER:YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY 0 V o o a 11.1a o RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTENQ z a z TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE VU ` I co RECORDJN(YOUR N9TICE OF COMMEN EMENT. _ Ix Q 1- z -__.� f0 0.v 3;�t.. .. .✓ (Signature of Owner or Agent) 7Lr.r, r 4 (Signature of Contractor) 0 Ili uJ a it m /1L fin, �£'il(�k r,'% (] GG LII-- LD 0 Signed and sworn to(or affirmed)before me this// day of/ �/Signed and sworn to(or affirmed)before me thisi day w Q w c-D. � .‘2(..1)./q b a '4 i1x ri ha/b k i/l Or 1-1" ,a-u/ by�•,.{(.�,.• T}1 5 yr S U 07 w W VELMA JEAN NULL }�KPW b ..�L_c l"'�'r"'t"v._ > 7 Notary Public,State of Oklahoma (Signal re of Notary) ;.wy!•.•, SANDRA C SEMRO of Votary) ui LC cC Commission#00006048 ;. ,•,'`t My Commission Expires 04-12-2020 P `' MY COMMISSION#FF981169 �.I••'.---'ti•' ..m - ( ] ->..•r�',KnovILDFMIES June 03,2020 JA_Produced Identification ! t-)Rtrnciapiyh,elentific om e Type of Identification:in t I e)a(r! -F.0 3•w Type of Identification: /- rrl `-.a--t..y.S e MAP SHOWING BOUNDARY SURVEY OF 10. 15--A. 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E-E- - LAND SURVEYS 0 C.CAS IRUC.:11014 SURVEYS tt',.....-.---;,..;.. 6[113I VISIONS .. ..... -. s .a o X,' II-• 0 0 \ 2 ot_J y,: City of Atlantic Beach APPLICATION NUMBER 0Building Department (To be assigned by the Building Department.) r '� 800 Seminole Road [ i t/ ; �� Atlantic Beach, Florida 32233-5445 1 l -001- \\,„.. / Phone(904)247-5826 • Fax(904)247-5845 l0 I-Z L Le7 �1fi qr E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: (0,..S—LI ANAfjL ati( , De artment review required Yes No —(� Idin Applicant: C l 3-e--1Y li -Pe_ 1C_�n__ Plannin_g &Zonin Tree Administrator Project: el t ( l I .--moi 1(I P . Public Utilities, Public Safety 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: i APPLICATION STATUS Reviewing Department First Review: 21'Approved. Denied. I INot applicable (Circle one.) Comments: BUILDING PLANNING&ZONING "--��/ I Reviewed by: ` Date: a-1_1- 11 TREE ADMIN. Second Review: Approved as revised. I Denied. ['Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES • PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: Approved as revised. Denied. I INot applicable Comments: Reviewed by: Date: Revised 05/19/2017 SJar�; City of Atlantic Beach APPLICATION NUMBER j1 tditic,d Building Department irtiF C. � ,.s (To be assigned by the Building Department.) r � 800 Seminole Road C / /1, r, 111- ! `l a Atlantic Beach, Florida 32233-5445 QCT 2 2 2019 ` Phone(904)247-5826 • Fax(904)247-584 LtJ W 1C)111. i 1� Da 9:- E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: COS-(4 wjL101( , Deyartment review required Yes No Idi '— Applicant: -ivy �S f nt_r1c Plannin. & Zonin• Tree Administrator Project: (� L0— h ...T0-4)C1 P Work. Public Utilities Public Safety 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: I 'Approved. Zenied. ['Not applicable (Circle one.) Comments: BUILDING PLANNINGt First •Review: I b / /r ~_ Date:/0 --Al 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 PUBLIC WORKS PLAN REVIEW COMMENTS Date: / .- -/ Application#: '4/ y'� 0;77 Project Address: 1 '-11 %2f/tiC CORRECTION ITEMS Check Box to Select CSMP Provide construction site management plan including location of silt fence, dumpster, portable toilet. ❑ Right-of-Way Permit is required if using right-of-way for construction parking. DPLN Provide drainage plans showing site topography(flow arrows, etc.). 0 ESCP Provide erosion and sediment control plans with installation details. 0 IMPS Provide impervious surface calculations for entire lot(existing and post construction). 0 Section 24-66(b) of the Land Development Regulations requires on-site storage for increased run-off LDCS if adding 250 SF or more impervious surface. Provide Delta volume calculations and on-site retention 0 required per Section 24-66(b). REPM A Revocable Encroachment Agreement must be submitted. RMRO All runoff must remain on-site. Cannot raise lot elevation. 0 RWPM A Right-of-Way Permit must be obtained. 0 TSUR Provide a pre-construction topographic survey prepared by a Florida Licensed Professional Land ❑ Surveyor, showing 1' contours. CUT Provide manufacturer cut sheets for 50%credit on Turf Block pavers. ❑ DW Maximum driveway width within the City right-of-way is 20' (circular driveway width is 12' maximum). 0 PAV Provide paver installation method (must meet I.C.P.I.). 0 WRA Provide a detailed plan of water retention area and how water runoff gets to water retention ❑ areas and then to street. WR Provide detailed plans showing proposed water retention. 0 SID Concrete sidewalk must continue through driveway. 0 50 Documentation shows impervious areas are over the 45%allowed by City code. 0 0 Revised 2/26/19 PUBLIC WORKS PLAN REVIEW COMMENTS Date: � — (727--1 9 Application#: /V Gr/ r''aV� Protect Address: C ' 127,1 J J G CONDITIONS OF APPROVAL TO PRINT ON PERMIT Check Box to Select All concrete driveway aprons must be 5" thick,4000 psi,with fibermesh from edge of pavement Driveway to the property line. Reinforcing rods or mesh are not allowed in the right-of-way. 0 Apron (Commercial driveways—6"thick). Full erosion control measures must be installed and approved prior to beginning any earth Erosion disturbing activities. Contact the Inspection Line (247-5814) to request an Erosion and Sediment 0 Control Control Inspection prior to start of construction. Onsite All runoff must remain on-site during construction. Runoff Post Const. If on-site storage is required, a post construction topographic survey documenting proper TOPO construction will be required. All water runoff must go to retention area and retention overflow 0 Survey must run to street. Pool Pool—Wellpoint(if used) must discharge into vegetated area 10' minimum from street or drainage ❑ Wellpoint feature(swale, structure or lagoon). Roll off container company must be on City approved list (Advanced Disposal, Realco Recycling, Roll off Shapells, Inc., Republic Services, Donovan Dumpsters, Phillips Containers,JDog/Dennis Junk Container Removal,All American Roll Off,WCA Waste Corporation). Container cannot be placed on City ROW. ROW Restoration Full right-of-way restoration, including sod, is required. 4r Utility Any utility cuts in the road must be repaired using COJ Standard Detail Case X and must be overlaid ❑ Road Cut 10' in each direction from the center of the cut. Repair must be shown on the plans. Construction Provide construction site management plan, including location of silt fence, dumpster, portable ❑ Site Mgmt. toilet. Right-of-Way Permit is required if using right-of-way for construction parking. Runoff All runoff must remain on-site. Cannot raise lot elevation. Document Strongly suggest thorough documentation of impervious areas be recorded. 0 Impervious Slab Slab and driveway to be fully removed. 0 Driveway Maximum Maximum driveway width within the City right-of-way is 20'. 0 Driveway Circular Maximum circular driveway width within the City right-of-way is 12'. 0 Driveway Grass Full site to be grassed. 0 TOPMust provide a topographic (TOPO) survey with water retention for final CO Inspection. 0 Survey Revision Any plan change must be submitted as a Revision to the Building Department. 0 Fencing All old fencing and debris must be removed from job site by Contractor. w 7. Removed Decking All old decking and debris must be removed from job site by Contractor. ❑ Removed Infra- Any damage done to infrastructure must be repaired by Contractor. structure Revised 2/26/19 (-,: ‘_-s .,I,.� City of Atlantic Beach APPLICATION NUMBER ori �� Building Department f ECEIVE 1 (To be assigned by the Building Department.) r 800 Seminole Road r F IJ Er/- A Z� O 1 `1- `•' Atlantic Beach, Florida 32233-5445 9CT 2 2 2019 c� Phone(904)247-5826• Fax(904)247-584 l Id [c7�,: qY E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: COS-(A A ittk 1tk\L. at/ , Dee artment review required Yes No N -,((��� r,, IdiomApplicant: 4`t-f 1 lS ce ILL t rI c Planning & Zonin (� Tree Administrator Project: f� d I 1 !O-(l L - P - Public Utilities1 Public Safety 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. Ienied. UNot applicable (Circle one.) Comments: BUILDING PLANNING &ZONING `� / • Reviewed by: Date:IC- j`_ i TREE ADMIN. Second Review: Approved as revised. ❑Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed byi----(,_��/,//� , �_ Date: dr FIRE SERVICES Third Review: I ]Approved as revised. ['Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05119/2017 r1�yLl j.. Revision Request/Correction to Comments **ALL INFORMATION _ HIGHLIGHTED IN �"! City of Atlantic Beach Building Department GRAY IS REQUIRED. ' j 800 Seminole Rd, Atlantic Beach, FL 32233 \` Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: l-Ne l 1 -DI a..7 Revision to Issued Permit OR l corrections to Comments Date: I 4 / l ai Project Address: 6,S 4- (3 l..) ATI Q � (e.--- c e -- Contractor/Contact Name: LI , c-) Nr-- (.._( -.___. reap_ ,,G) J Contact Phone: Email: Description Proposed Revision/Corrections:ion . (--- E- -)C- --CD AC- kr (_-_-__ _) ( I affirm the revision/correction to comments is inclusive of the proposed changes. (printed name) • Will proposed revision/corrections add additional square footage to original submittal? ❑No ❑ Yes (additional s.f.to be added: ) • Will proposed revision/corrections add additional increase in building value to original submittal? ❑No ❑*Yes (additional increase in building value: $ ) (Contractor must sign if increase in valuation) *Signature of Contractor/Agent: (Office Use Only) pp roved ❑ Denied ❑ Not Applicable to Department Permit Fee Due$ Revision/Plan Review Comments Department Review Required: -, GENE Building i,r, �— Planning&Zoning eviewed By Tree Administrator NOV 05 2019 u lc o / Puc Utttfittes /( >->/ Public Safety Date/ Fire Services Updated 10/17/18 REVOCABLE ENCROACHMENT AGREEMENT City of Atlantic Beach "All INFORMATION = HIGHLIGHTED IN GRAY 800 Seminole Road, Atlantic Beach, FL 32233 IS REQUIRED. REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the State of Florida, hereinafter referred to as "CITY" and 4 i' of Atlantic Beach, Florida, hereinafter referred to as "USER" WITNESSETH: That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to enter upon the property for the purpose as described in the City of Atlantic Beach. This work is generally described as Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to relocation or removal on thirty(30) days' notice by CITY to USER, said notice to USER shall be given by certified mail,return receipt requested, to the following address %r fit ' L. _ • 2 2 iS • In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter upon the above described easement or property of the CITY, the USER shall replace at the USER's sole expense, any and all material necessarily displaced during the action of maintaining, repairing, operating, replacing or adding to of the utilities and facilities of the CITY or franchise utility provider. • The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes, Land Development Code and all other land use and code requirements of the CITY, including City Code Section 19-7(h) which states "Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but must be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks." • The USER, prior to making any changes from the approved plans and/or method, must obtain written approval from the City of Atlantic Beach Public Works Department, for said change within 30 days after the day of completion. • This permit shall inure to the benefit of, and be binding upon, the USER and their respective successors and assigns. • USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or specifications, to include utilities locate requirements and use limitations/requirements of easements, public right-of-ways and other public land. USER further agrees that the CITY and its officers and employees shall be saved harmless by the USER from any of the work herein under the terms of this permit and that all of said liabiies are hereby assumed by the USER. Date Property Owner/Agent (signed in presence of Notary Public) K oN iw rsri u n z ,c441 Lair[ STATE OF'F&IiideCLOUNTY OF ©UbAL"_+ak�'�l�p� / The foregoing instrument was acknowledged this day of ,'.' 20 / , by t C't l.i r7 ,1rJ-J f It 1'1 Li. >j +! J t/ . who personally appeared before me and (printed name of Signer) acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. VELMA JEAN NULL E' < f lI rt l C_ Notary Public, State of Oklahoma Department Approval: Signature of Notary Public, State of Florida Commission I 00006048 My Commission Expires 04-12-2020 ( ]Personally Known 1 ,/ ('j,Produced Identification(Type] „ T'2 Scott Williams, Public Works Director 't.Appikacrons&rtwm)\Word ucc..mrr:t0,2018083i Nev,x4bic E^crcac'snieni Arcernen;dxi. Revsion Date:B/31,;8 r51, 1T City of Atlantic Beach APPLICATION NUMBER Js Building Department (To be assigned by the Building Department.) �' 800 Seminole Road 1 ckt /, i� Atlantic Beach, Florida 32233-5445 r `- —0 /39- _...) Phone(904)247-5826 - Fax(904)247-5845 tO I�L le7 \,(4011) E-mail: building-dept@coab.us Date routed: City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: LOS-(A l'lk$ (._b1( , DDeiT tment review required Yes No Idin Applicant: 15 tNy lS nLi .,.i...t " t i iii. to. d.,,,,:_ i,,,,,„ ,,, , , ., : ' .r 642 ,PX 11. 14 Yi , , ..,......... f ...� • ‘ II I.., „ .- ..../. . .„... at,: , ., ..., \ ..L-::;;:.,.,,,,, 4.,_. , ... ,, . ., .,, . ,.. . . ..... .: .a. 74, . , t - M: +.. jI t i r .,.. . A.,;;;,. . ..,:„.• ..... .... _ , . "mit 10" SEWER MAIN Q * L 1 654 • y. k• 4e` ,,, :,,,,,,,,,,.,A, . ,. . . •, „.. . . Qa'} - ar (_ Tt' � �. e- 4.y