566 PLAZA RFNC22-0009 revision 2-16-22 Revision Request/Correction to Comments "ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
'" Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: KSIJG2 2 000�
❑ Revision to Issued Permit OR ❑ Corrections to Comments Date: (111Z-2--
Project
Address: 5..“ (cq-ci / t 4 )t c f 32-233
Contractor/Contact Name: 5 S ��1n�
Contact Phone: ( t.04C 5) ' 3524, Email: Omo55y�b�'r� t�°OCan
Description of Proposed Revision/Corrections:
R_v occAl czerI A-
Ib \ affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• Will proposed revision/corrections add additional square footage to original submittal?
, No ❑ Yes (additional s.f.to be added:
• Wil proposed revision/corrections add additional increase in building value to original submittal?
No ❑*Yes (additional increase in building value:$kte )(Contractor must sign if increase in valuation)
974*Signature of Contractor/Agent:
(Office Use Only)
❑ Approved ❑ Denied ❑ Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comments
Department Review Required:
Building
Planning&Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services Updated 10/17/18
REVOCABLE ENCROACHMENT AGREEMENT
4\ City of Atlantic Beach **ALL INFORMATION
800 Seminole Road,Atlantic Beach,FL 32233 HIGHLIGHTED IN GRAY
IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach, Florida,a municipal corporation organized and
existing under thq laws of the State of Florida, hereinafter referred to as "CITY" and
�b \Y\ 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 '��t c.R__ 1 wocc "r CQ
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains subject to
relocation or removal on thirty(30)days'notice by CITY to USER,slid notice to USER shall be given by certified mail,return
receipt requested,to the following address 56,1-? Q(01-01 R }��� c 227,3 .
• In the event it is necessary for the CITY or the City's approved representative or other franchised utility to enter
upon the above described easement or property of the CITY, the USER shall replace at the USER's sole expense,
any and all material necessarily displaced during the action of maintaining, repairing, operating, replacing or
adding to of the utilities and facilities of the CITY or franchise utility provider.
• The facilities allowed by the permit shall meet the current requirements of the City Code, Building Codes, Land
Development Code and all other land use and code requirements of the CITY, including City Code Section 19-7(h)
which states "Driveways that cross sidewalks: City sidewalks may not be replaced with other materials, but must
be replaced with smooth concrete left natural in color so that it matches the existing and adjoining sidewalks."
• The USER, prior to making any changes from the approved plans and/or method, must obtain written approval
from the City of Atlantic Beach Public Works Department, for said change within 30 days after the day of
completion.
• This permit shall inure to the benefit of, and be binding upon, the USER and their respective successors and
assigns.
• USER shall meet the terms and conditions of this permit and to all of the applicable State and CITY laws and/or
specifications, to include utilities locate requirements and use limitations/requirements of easements, public
right-of-ways and other public land. USER further agrees that the CITY and its officers and employees shall be
saved harmless by the USER from any of the work herein under the terms of this permit and that all of said
liabilities are hereby assumed by the USER. �1
.l pj4 Date
Propert Owner/Agent(signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this � day of , 20 ZZ,
by S0nv\ ,who personally appeared before me and
(printed name of Signer)
ackn wI dged t he e signed the instrument voluntarily for the purpose expressed in it.
C4-- Department Approval:
Signa ure of Notary Public,State Florida ESPERGER
;.: MY COMMIggION#
[ ] Personally Known ,:,� X8.53178
EXPIRES:October '2023
[ ]Produced Identification(Type) Bond �uNotayp„ ku
ott Williams, Public Works Director
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18