2332 Barefoot Tr Driveway Submittal `= 1 Building Permit Application Updated 10/9/18
1„.,`# j City of Atlantic Beach Building Department **ALL INFORMATION
_,. 7� 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
�' ttt' IS REQUIRED.
Phone: (904) 247-5826 Email: Building-Dept@coab.us
Job Address: 233 .,. r'„ ,.x.e ,: _--- Z ,•S.. ,C Permit Number:
Legal Description`j�-,c2i `�;; _4s, - Z `, e �> - & Cc,” C--)-2 1 R Cc, 5 RE# 1 .c'`l) 1,-:,_5 C: d-;IS
Valuation of Work(Replacement Cost)$ /2 ,t;4 .. --- Heated/Cooled SF Non-Heate
• Class of Work: ENew DAddition 1314teration ,Repair '?Move :Memo ❑Pool DWindow or NOV 3 0 2021
• Use of existing/proposed structure(s): ❑Commercial CE/Residential
• If an existing structure,is a fire sprinkler system installed?: CIYes ilNo BY:
• Will treeJs0e removed in association with proposedproiect? LJYes(must submit separate Tree Removal Permit) El'No
Describe in detail the type of work to be performed: )
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7'1 1' t- L , v `'S r"-1
Florida Product Approval# for multiple products use product approval form
PropertyOwner Information
Name p_kfAT 7P4 2,40 Address 2„,1 3Z f3 Ailif'wT 7Z4
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City ATI-ANr)` geolc-01 State re• Zip 3211 3S Phone 7C9-4. .,_ t92
E-Mail oPZO et C o 41045/• Ne T
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required)
Contractor Information
Name of Company r r,,r) r, e->S.-r-w-z ,.....;..t,vs'..b.--w..y.z.iie, Qualifying Agent w'i c." 'r..: .rA. 'I.,&...v1e,"--
Address c ti (;. ,IS-erutL... cls City_`5'"t-4.-ws ,.+-fcc.0 State r- L Zip_"32 zs'�'-`-t
Office Phone *c -.-A 'is-2'c-Z Zti Job Site Contact Number
State Certification/Registration# 7 s'2. t CLI 5 E.-Mak QA-c.,---‘1..‘„t4'.0-u z.G Gt -10,,.,,5 e -.vs1 ra tk_ , Lv-^'1
Architect Name&Phone#
Engineer's Name&Phone#
Workers Compensation Insurer /-t cl A OR Exempt CI Expiration Date 2. le z ,i'r'Z,_
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 regulating
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 OBN Fl ANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
REC N U OTIC!' COMMENCEMENT. „,,------77„-- j'
(Signature of Owner or e.,
) (Signature of Contractor)
Signed and sworn to(or affirmed before me thiyfr(zie
day of Si ed and sworn to(or affirmed)before�� Jmethis j,"day of
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FOR, 004.41eR etAstste Atimed$
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' SO CITY OF ATLANTIC BEACH
,•%- - --,•,'-e,. ..;,,
.0 .tio r
SOO SEMINOLE ROAD
ATLANTIC REACH,FL 32233
(904)2474300
REVOCABLE ENCROACHMENT AGREEMENT
"ALL 84FOIMIATION
City of Atlantic Beach
lerH1GHUGHT D GUY
tic: lir
800 Seminole Road,Atlantic Beach,FL 32233
#SiRr !#REfl
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
a .:;Q `, (7,11~? 1 0 , „ 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 4:--)‘"4-,,:
RIGHT-OF-WAY/EASEMENT PERMIT APPLICATION **ALL INFORMATION
410,
City of Atlantic Beach HIGHLIGHTED iN GRAY IS
$. 800 Seminole Road,Atlantic Beach,FL 32233 REQUIRED.
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address 2";3 Z %'r+k Gt u r v+ C b Permit Number
Contractor Information
Company L't:tewt- ,c, C -' f n t :Kam cra�,� i c C. Qualifying Agent ti 4r ve.2
Address -4;-- It j ti 4e :57 City 5 ca f i� Statet:s Zip 32
Phone(- 'r:y) <-)<-/S— —2:°°. '"S EmailCti.<4- 'fcas--f) L,v•40 lc
v�
State Certification/Registration# 2. '52_ w
Architect Phone Email
Engineer Phone Email
Workers Compensation Insurer F u r? OR Exempt®Expiration Date :/22. /x;-_
• Permittee declares that prior to filing this application they have ascertained the location of all existing utilities,both aerial
and underground and the accurate locations are shown on the sketches.
• Whenever necessary for the construction,repair, improvement, maintenance,safe and efficient operation,alteration or
relocation of all,or any portion of said street or easement as determined by the Public Works Director,any or all said poles,
wires,pipes, cables or other facilities and appurtenances authorized hereunder,shall be immediately removed from said
street or easement or reset or relocated hereon as required by the Public Works Director and at the expense of the
Permittee unless reimbursement is authorized.
• All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed under the
supervision of i•��,k_L r4¢ tr,;:,�G: • (Project Superintendent)
with(Company Name) 11,0,‘-,-714c, G,A Phone
• All materials and equipment shall be subject to inspection by the Public Works Director.
• All city property shall be restored to its original condition as far as practical,in keeping with City specifications and the
manner satisfactory to the City.
• A sketch of plans covering details of this installation,as well as a copy of a recent survey shall be made a part of this permit.
Calculations showing any increase in impervious area on owner's lot or in the City right-of-way are to be included with
this application.
• The permittee shall commence actual construction in good faith within 3;, days. If the beginning date is more than 60
days from date of permit approval then permittee must review the permit with the Public Works Director to make sure no
changes have occurred in the area that would affect the permitted construction.
• It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's right,
title and interest in the land to be entered upon and used by the holder,and the holder will,at all times,assume all risk of
and indemnify,defend and save harmless the City of Atlantic Beach from and against any and all loss,damage and cost of
expenses arising in any manner of the exercise or attempted exercises by the holder of the aforesaid rights and privileges.
• The Public Works Director,shail be notified 24 urs prior to starting work and again immediately upon completion.
--�--- Date // /1,1,2 /Z l
Permittee(signed in presence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing� f) f instrument was acknowledged this! 1 (� day of of V�on be `~ ,20 c1-1, ,
by��i `' t`t CI- p L71 , "personally appeared before mend
(printed name of P rmittee)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it,
,pr votary
PuCuc State or Fronde
w
4,141, Wanda C Tucker
/ J`Y��Y �' 4:'(-7-;p:-.)6#
yyo MyFComm salon vG 7021;
��/ G^T � aM1 r_x Fres Ot'0620?2
Notary
_ Personally Known
S:nature of Notary Public,Sta of Florida [ j Produced Identification(Type) _._
H:\Applications&Forms\Word Documents\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18