640 Orchid Lane DRTV-13-00100050
APPLICATION REVIEW AND TRACKING FORM
Property Ad dress: ______________________________
Applicant: ____________________________________
Project: _______________________________________
Review fee $________________ Dept Signature __________________
APPLICATION STATUS
Reviewing Department
(Circle one.)
BUILDING
PLANNING & ZONING
TREE ADMIN.
PUBLIC WORKS
PUBLIC UTILITIES
PUBLIC SAFETY
FIRE SERVICES
First Review: Approved. Denied.
Comments:
Reviewed by:__________________________ Date:______________
Second Review: Approved as revised. Denied.
Comments:
Reviewed by:__________________________ Date:______________
Third Review: Approved as revised. Denied.
Comments:
Reviewed by:__________________________ Date:______________
Revised 07/27/10
Department review required Yes No
Building Planning & Zoning Tree Administrator
Public Works
Public Works Public Utilities Public Safety Fire Services
Other Agency Review or Permit Required Review or Receipt
of Permit Verified By Date
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: _________________________________
City of Atlantic Beach
Building Department
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone (904) 247-5826 · Fax (904) 247-5845
E-mail: building-dept@coab.us
City web-site: http://www.coab.us
APPLICATION NUMBER
(To be assigned by the Building Department.)
________________________
Date routed: _______________________