510 Royal Palms Drive WAIV19-0001 Application 0 sirr LAND DEVELOPMENT REGULATIONS WAIVER APPLICATION
..: sa City of Atlantic Beach
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111"-� Community Development Department ' bC
— V800 Seminole Road Atlantic Beach,FL J2713 FOR INTERNAL OFFICE USE ONLY
t;;s (P)904 247 5800 FEB 2 5 2019 FILE# i AIV t oi-oo o 1
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SITE INFORMATION By
ADDRESS 5 /0c c,J/4.0 P4 /4/4 S n-
SUBDIVISION 4Yee //,_/t S BLOCK 7 LOT .7
RE# / 7 i' 5 1 Cf -0060 E RESIDENTIAL ❑ COMMERCIAL ❑ OTHER
APPLICANT
�(INFORMATION
NAME �J(3....,4 r, (el EMAIL 0 Ptdl 4 C he/Is 6 v IA. /1
ADDRESS 5/ 0 ;!`fid V o ( Pa tiie'/3 Pr CITY / STATE iq.. ZIP CODE 322_3
PROPERTY LOCATION 5/0 �� Alp '
� y��( � S Ar , PHONE# 7Uc( 7yr-j6..f)CELL# 5-1_,3•-3 6. /
RE# 1 7/5/1-OOo O LOT/PARCEL SIZE � 311 SO ZONING COVE
COMPREHENSIVE PLAN FUTURE LAND USE DESIGNATION gni/v/
REQUESTED PROVISIONS FROM WHICH WAIVER IS GH f't ACS,/ `* OP^rt Le S 5 7,--'L
Ioo -Fi-
PROVIDE ALL OF THE FOLLOWING INFORMATION:
1. Proof of ownership(deed or cerLert
cate by la\vyer or abstract c ,mpany or title company that ve ie ecord of o ner as above
2. Survey and legal description ofy
3. If the applicant is not the owner, rovide a letter of authorization from the owner(s)for a plicar�t to repr nt the owner for all
purposes related to this applicatio
4. Application fee of 5250.00
I HEREBY CERTIFY THAT ALL INF6RMATION PROVIDED IS CORRECT:Signature of Prop Own (s)or Authorized Agent
4111
. — at4 2- 2 (--/9
SIGN 'RE OF AP' CAN PRINT OR TYPE NAME DATE
SIGNATURE OF APPLICANT(2) PRINT ORR TYPE NAME DATE
Signed and sworn before me on this Z Z.—day of V �_� by State of r (
County of aV i
Identification verified:
Oath Sworn: ❑ Yes ❑ No , : ; _ f
Fj>rP%�i, TONI GINULESPERGER ��
�r, MYCOMMISSION#FF924951 Notary Signature
;� EXPIRES:October 6,2019
' �" Bonded Thru Notary Publir..Underwriters
L:=_—.a-'---- --- ,My Commission expires
:1^ N.e4T' YV'xYaa¢C .. .�... ....
15 LAND DEV REGULATION WAIVER 03.01.2018