1884 sea oats dr dway22-0012 f='''r, Building Permit Application Updated 10/9/18
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T� City of Atlantic Beach Building Department **ALL INFORMATION
�� 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
-cm pr IS REQUIRED.
Phone: (904)big Of*247-5826� Email: Building-Dept@coab.us w t p ,�
Job Address: iFig • .�l�rrt ji PA a 3 � t
ermit Number: C\(( Z Z `0O' Z
. Legal Description 36F LO o -7-5 -2 9 e 5,1.1.../4.-ew-g,„/A, di/, 9 RE# /7Q2.OZO - &OP
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Valuation of Work(Replacement Cost)$ q 7 00. 00 Heated/CooledZLSFgCL Non-Heated/Cooled
• Class of Work: ❑New ❑Addition ❑Alteration kiepair ❑Move ElDemo ❑Pool ❑Window/Door
• Use of existing/proposed structure(s): ❑Commercial !(Residential
• If an existing structure,is a fire sprinkler system installed?: ❑Yes IONo
• Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) XNo _
Describe in detail the type of work to be performed: jZA,"10/2 /Lx#S rr4-[moo d[-,4.z-J 5t-A3 %),2,441-,AllffitiMio.
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Florida Product Approval# for multiple products use product approval form
Property Owner Information R'L r -
Name J�1✓) P 5ht1ie✓, r. f f'�"'JCccri .ckt(kddress I�'�Y £2U ads Y. /- 1
City G �/ State , Zip 3ZZ3- Phone -j/f� l�7c yeqry g5Z1
E-Mail Johh ((.evot2LSit. .life
Owner or Agent(If Agent, Power of Attorney or Agency Letter Required)
Contractor Informatjpfl - ,iG&
Name of C m apy l ,el Qualifyin Agent
Address i/ . "2J7�' _i N / / City ,e State -- Zip 'c '-5-?-
Office
�
Office Phone iW ,?6.97- �o Job Site C tact umber (21/36/- sr... 6'.-
State Certification/Registration#,eS"323,29 ' E-Mail C 4./Zi9 49 / OW.CO.
Architect Name&Phone# /0//•.jA ;f6-1";5-
Engineer's Name&Phone#
Workers Compensation Insurer /J)( f)/p/73L9-49- ( /c, OR Exempt❑ Expiration Date /2/340/2e
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 OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN 0 N Y BEFORE
RECORD U N ICE OF COMMENCEMENT.
(Signature of Owner or Agent) (Signature of Contractor
2.3
fined and sworn to(oit
before this7 2 day of igraeed, nd sworn to(or affir, ed)before me this,day of
Feb , ?(-)Z1 'Y 'c '-/-/'c '-/-/ /I,LL �.LL 'x .27,by W__.• d. • 'u(1 ['t _ i II Ck___
: :ii:V!� ,, TONI GINDLESPE�G � ,. . iotaryjv ..Signature 4 )
;,. ,; MY COMMISSION#GG t 78 64.------,. •', EXPIRES:October 6,2023 �- �.Eo ?; BondedThruNotaryPubicUnder Mts A c\------.)
[ )Produced Identification •.F dduced Itilaiti®lieSTSPE
Type of Identification: . l =' ) df F�IeplyfQpMhYfiSION#G�t18-"I
:,. :o EXPIRES:October 6,
�'''''.tdi oc;: Bonded nue Notary Public Underwriters
We plan to remove the existing concrete slab driveway and pavers on walkway and replace with new
pavers.We will bring driveway at 20ft or less in right of way for code.
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L/�'- 1 , REVOCABLE ENCROACHMENT AGREEMENT
('f City of Atlantic Beach **ALL INFORMATION
(� ig, —4,)1800 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 t e laws of the State of Florida, hereinafter referred to as "CITY" and
Joh v1 F. Jhtt(tV j{. )?f14 fek a'C Or. 4-g 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 Cityof Atlantic Beach. 1-' ' - nk apl.4-t- 2-s,ttin d V't\W � P'" �'1
P P Y P P n 1Nkl t try fps hole/. � - lM tl (1plat L,D bi P It CS
�`� ��i�1/tfi
This work is generally described as ( Q10Ee-mad of :Q.`69h (2h.ev5T '' W°U-Ic .4)' tel° .
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,said notice to USER shall be given by certified mail, return
receipt requested, to the following address /S ...5i .4 og D21,/r,,_ /4./3 3L2-33 .
• 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 har less by the USER fro • -ny of the work herein under the terms of this permit and that all of said
liabilit s re h y ass,u- • 'y t r - USER.
' _ . ( G �(, Date �� 2 i✓/Z/
Property 0 ner/Agent (signed in presence of Notary Public) (((
STATE OF FLORIDA, COUNTY OF DUVAL \
The foregoing instrument1� was acknowledged this a D- day of F( bILk c4� d( , 20 a ,
by St1 `` , who personally appeared before me and
(printed name of Signer)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
�""�° ��'' JENNIFER JOHNSTON
MYC0 7519 Department Approval:
•' MISSION HH
Signature of If
Public, State of Florida o PIRES:October27,Zpyq
[ ] Personally Known " •rs
[produced Identification (Type) F(...._ .1)( _ Scott Williams, Public Works Director
H:\Applications&Forms\Word&Excel Document Originals\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18
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