535 Atlantic BlvdAPPLICATION FOR LAND DEVELOPMENT REGULATIONS WAIVER
City of Atlantic Beach 800 Seminole Road Atlantic Beach, Florida 32233
Phone: (904) 247-5826 FAX (904) 247-5845 • http://www.coab.us
Date 69 1 D File No. �q 5/� 1, Receipt
Section 24-46 (d) permits the City Commission to authorize limited Waivers, on a case-by-case basis, from a
specific provision(s) of these Land Development Regulations when it is demonstrated that compliance with
such provision(s) would be unreasonable, in conflict with the public interest, or a practical impossibility. A
Waiver from these Land Development Regulations may be approved only upon showing of good cause, and
upon evidence that an alternative to a specific provision(s) of this Chapter shall be provided, which conforms to
the general intent and spirit of these Land Development Regulations. In considering any request for a Waiver
from these Land Development Regulations, the City Commission may require conditions as appropriate to
ensure that the intent of these Land Development Regulations is enforced. A Waiver shall not modify any
requirement or term customarily considered as a Variance or any requirement or term prohibited as a
Variance, and shall be considered only in cases where alternative administrative procedures are not set for the
within the City Code of Ordinances.
1. Applicant's Name
2. Applicant's Addre�
3. Property Location
4. Property Appraiser's Real Estate Number � [(f in %j -�{' � (JVUU
5. Current Zoning Classification 6. Co/mp�reehensiive P1aa ruture Land use d(e�siig1nationn
7. Requested provision(s) from which waiver is sought: �( '�1 !' l J l ! OAK n('T ' 1 (7(
8. Size of Parcel � • � Ci�'e5 9. Utility Provider ��
10. Provide all of the following information:
a. Proof of ownership (deed or certificate by lawyer or abstract company or title company that verifies record
owner as above). If the applicant is not the owner, a letter of authorization from the owner(s) for applicant to
represent the owner for all purposes related to this application must be provided.
b. Survey and legal description of property.
c. Required number of copies (2)
d. Application Fee ($250.00)
I HEREBY CERTIFY THAT ALL INFORMATION PROVIDED WITH THIS APPLICATION IS CORRECT:
Signature of owners) or authorizeOd person if owner's authorization form is attached:
Signature(s):
ADDRESS AND CONTACT INFORMATION OF PERSON TO RECEIVE ALL CORRESPONDENCE REGARDING THIS
APPLICATION
Name: �-2�-� 'HI/64 C
Mailing Address: U®� /Y� I rt0,� 0CJ r�
Phone: Q04 �q7 5<h 17 Fax: qo 7" Jam$ � E-mail:__Jti(165CA CS�Crz{6.US
10. Statement of facts and any special reasons for the requested Waiver, which demonstrates compliance with
Section 24-46 (d) of the Zoning and Subdivision and Land Development Regulations and specifically
describing how the request complies with the Conditions necessary for the City Commission to approve this
request. Please attach additional pages if needed.