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2233 Seminole Unit 1 RESO18-0034 App SyLvf City of Atlantic Beach APPLICATION NUMBER ;,A� ► ��, Building Department EClJ J (To be assigned by the Building Departm nt.) A - 800 Seminole Road Q Eso/O',.,6 j�3 D_.,. �r Atlantic Beach, Florida 32233-5445 JUN 14 2018 1\ Q w Phone(904)247-5826 • Fax(904)247-5 // / ry j 3�? E-mail: building-dept@coab.us Date routed: / !3 l 0 / ab. s BY 1` City web site. http/www.co u APPLICATION REVIEW AND TRACKING FORM Property Address: 27-33 ��'�--1►4���A r : Department review required Yes No Building Applicant: J<t4eJi. l Planning &Zoning l r,� Tree Administrator Project: Recy'vvc Pa 1 O i Peptace, - •' - Pa',.., l�l( • ic , i - / V ,r3 Public Safety `` Fire Services Review fee Of K Dept Signature ,--N � 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: BUILDING PLANNING &ZONING Reviewed by: 4-76 It/ Date: 6//C/1 i 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 �Sr1/JrJ� City of Atlantic Beach :IZCEIVE APPLICATION NUMBER Js Building Department (To be assigned by the Building Departm nt.) A ;.) 800 Seminole Road JUN 14 2018 R EEo Ig'.-v a3 Atlantic Beach, Florida 32233-544 Phone(904)247-5826 • Fax(904) -5845 Yr �of �? E-mail: building-dept@coab.us Date routed: //3///r. City web-site: http.//www coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: Z7-33Department review required Yes No p Y Building Applicant: Ke. *e.,1t l �,Ci Planning &Zoning 1 Tree Administrator Project: Remove Pc:Lilo/ Pp1ac . ( is (J�/ pa,tiers 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: 14proved. ['Denied. ['Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by:LIC1a2)1g�6o,Z 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 m LEGE11V 1] 0%0''y Building Permit Application JUN 1 u`�dp 82/8 A City of Atlantic Beach *SAP,IW 800 Seminole Road,Atlantic Beach,FL 32233 --- � Phone:(904)247-5826 Fax:(904)247-5845 Job Address: 22 ✓?, 3 _C�/Yr/qj'!Q h r/� Q41.4.if Permit Number:t -- Legal Description ©q�S_Vq k 0(04, V+ Hat. un17 1 to Om itri IRE# /(4 -/ -0/ z Valuation of Work(Replacement Cost)$,3110. 6 0 Heated/Cooled SF —Non-Heated/Cooled �---- • Class of Work(Circle one): New Addition Alteratio Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial Residential • If an existing structure, is a fire sprinkler system installed?(Circle one): Yes No N/A • Submit a Tragi Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal Describe in detail the type of work to be performed: Pqmetihi-e (ve/I-e ARID 4 / /ve,r5 Florida Product Approval# for multiple products use product approval form Property Owner Information Name: S.air Si Address: Si„•,,.- !.►S SQA City State Zip Phone y y3 Cu/ IL 3Z E-Mail Scot-5, S.l✓L/ Q G,1 .'f. co.,- Owner o. -Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information ` 1 Name of Company: i'`(J4/(/(II 7 r Quali ing A ent: Address 0�j0O /�y pt r4- a0p j City �n 1C, State EL. Zip Office Phone /1/-if 3ID ?2zG Job Site/Contact Numb r - -r ' a State Certification/Registration# E-Mail ;,,,,4 10 P�"'e' ,1%( • 1 Ph•, Architect Name&Phone# Engineer's Name&Phone# Workers Compensation On 1"-6.„ Exempt/Insurer/Lease Employees/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 regulationg 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. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE REC•RDING )1? • NOTICILQF�-OMMENCEMENT. liki'1 iiirl---- .,.. . ... ".....,_;.;, •• .77 (Sign. ure of Owner or Agent) % `- /" Sig tyre of Contractor) (inclu s contractor) Signed and sworn to(or affi -d before e :h"s da of Signed and sworn to(or af'c41ed)befo a me thi• i day o U ` j , (t�by A.&', i► 1� ;5'&, , 2;)/ . . i a , 1 lainifina , . • Ilii - (Signatur• • Nota ) (Si: a ' A.NotarytjNIGINOI E0ER ;�r _ MY COMMIStIOL Ff 924951 ;�q. . TONT G I PER ER `' o; EXPIRES:October 6,2019 [ ]Personally Known OR rso dally Known OR FF " �!� :h. ■= MY COMMIS • #FF 24 eT d ';rf °"' Bonded Thru Notary Public Underwriters I ]Produced Identification .rte EXPIRES:October 6,2b9odc�ed Identification —=^ Type of Identification: •'F_Jt-" Bonded ThruNo;aryPublicur�t 0Qf I,:ientification: _ I SMITH APPRAISAL SERVICES MC. fftl- F✓t2 ' 3* <S7'tx.►.t,- ( ' �1(t Crit ex�`-p7` Project Layout 5 iY. 61 LI,LAY" tri DNc S 11 Lb#-) I,:!•:: t; ;171.4 tl1'ic OetAA/ }: ,• ..Of F1CiAL RtGORQS: s• •• ; • •. .•• Nia mitt g� Ma Mr VP( •°, . , t41•It ". •'1 c• Iwtrwrs .limy e, al . • • .. .i,• _-.jt.�l .ri•w. ..—.r....la'...." ...." R. - . .'....... _ z _._:...� ' L: • .': pn• QI - ✓.. kr:4 ►�L ROI .tip 651 '•`rte • .� --- • ' l Lf NI NON I EN AM MI El�1N M _ * ' '7:;.1--• . 1111":41111 ,.. ••..-...„. Ira : 11._kAi' ,..„7.). . -Al:10* — .. • r : . . op ri _ 1 iirie_, ;..{-1 ,..:;•,i lai .. . .. : iLki ,..: ... ; I /.:.-,4:v rA IVz4. ' i /d.III1 .Le,; 1[•7 1 _ 3 .. I -6t) • v. - • ,..7.71E/, ,,;.. 40. ••..... • Vit, 't �� ,eVe-- , %1 04- 110 # . ., :04stainore • +,•;‘ s •i; e. : .,, .,,,„..;......rye. ... ....i.: IS X TO ..1... . 4 . .!..• ;•:' 6 >1 . .....-::-. ---........-...4;.-•. . \,e A t - - li•ot ilraptliartctitailk w"--7-".'—--"---' '''.: " kr"." 's' "-i--14 0.j" . . • r • BIWA liCie‘srl Kill :.:...c1 VOAROI fla A .::' Ilbitk.‘f, 7.A . �� i' ' '. 1 I e3-,„„...,A„)� •• •iiii . ,: ... . , .,i 3"r2 ' • foliar . SP :L 1 JI...ci..1 E., ea '--. .' - • - I i •�,�.'_ �o�•'S�I t 1 a•••t..-- r.•+.r�r•..•r.1w..+...�w.1•.1 n.••••,..n....met........‘�msMv sWss Y...M....'.•.•....T Tlsnflfl' ....•.rrw..s..w.•.r��•.vs..n+•n....wi. .SM•M•.w—..An w.• w•w..••••••••••••••M•.rM••Va 9 1 MINNOW :5=1-\nrr, TREE & VEGETATION AFFIDAVIT FOR INTERNAL OFFICE USE ONLY s 41 sJ City of Atlantic Beach PERMIT# .) Community Development Department 800 Seminole Road Atlantic Beach,FL 32233 -.0:3 s� (P)904-247-5800 SITE INFORMATION ADDRESS ZZ 33 , t9/ ADS u„1- SUBDIVISION 06.e '/x'11 L BLOCK I/277-PILOT RE# /b4f 5/ f- Wz- SIDENTIAL ❑ COMMERCIAL ❑ OTHER APPLICANT INFORMATION NAME 5a Vire/ PHONE# i ADDRESS / 3 :moi d1, ` D!►i Z C4II CELL# I qv/ /4 3 Z CITY 47 3. �t STATE ZIP CODE EMAIL Stv# SG Sac, e 6,16,./. 0%, N •WNER ❑ LEGAL AUTHORIZED AGENT I affirm that I have reviewed the provisions of Chapter 23, "Protection of Trees and Native Vegetation", of the Municipal Code of Ordinances for the City of Atlantic Beach Florida and/or I have participated in a pre- application meeting with the Administrator of those regulations. Subsequently, I affirm that no regulated trees and no regulated vegetation will be damaged, destroyed and/or removed from the above-described property and/or adjacent properties including right-of-way. 1 I HEREBY CERTIFY THAT AL IN RMATION PROVIDED IS CORRECT:Sign ture of Property Owner(s)or Authorized A ent -- ccS-C -.- T Ltirv_ De 6 16 "S-lGIsATURE! P CANT PRINT OR TYPE NAME DATE SIGNATURE OF APPLICANT(2) PRINT OR TYPE NAME DATE Signed and sworn before me on this 13 day of t by State of County of 1. V cx-i Identification verified: S 4-LCd=788"sG-zz4 -D Oath Sworn: ❑ Yes ❑ No 11, TONI GINDLESPERGER , --'4--C-4s(::::)'----- Notary Sign. •re =y;k.',.1: MY COMMISSION#FF 924951 1,.... .i31 EXPIRES:October 6,2019 My Commission expires '•.'P F 4'' Bondod Thru Notary Public Underwriters 04 TREE AND VEGETATION AFFIDAVIT' .• .