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295 BELVEDERE ST DWAY22-0034 move driveway location Building Permit Application Updated 10/9/18 II'r: '' . City of Atlantic Beach Building Department **ALL INFORMATION / 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY `,,a,y ,; ,;cA7,;y„ RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION '$ n+', City of Atlantic Beach HIGHLIGHTED IN GRAY IS 75.. `� 800 Seminole Road,Atlantic Beach,FL 32233 REQUIRED. '�9r PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES Job Address ACLS ISP lv'f dt(C-, Sk-• Ahtt.4` Ile, k Permit Number Contractor Information Company I rvp.Lf.-' Rye/4 1\ E F L Qualifying Agent 1-0()_1 1 R1 &� Address 111 V 11 1 k 1..4-iNe. City1 te2 a"2J �x �-e. State � Zip 3 Phone C\04 �)� q\00 Email )O(.{K i-► (-1 -,6) 1,(1_7 ) cw1 vcrSN�Fi, .ph', State Certification/Registration# ` Architect Phone Email Engineer Phone Email Workers Compensation Insurer OR Exempt❑Expiration Date • 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 -Dl.�,� R; c I,\ (Project Superintendent) with(Company Name)--I (t,P;c--Q fI vel c, 0'e-rZ- Phone 9 U 41- ?L1 gj o ta • All materials and equipment shall be subject to ins ction 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 30 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 Pu. • orks Director shall be notified 24 hours prior to starting work and again immediately upon completion. Date S'a t4 ' g 3— Permittee(signed in p e -nce of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL y-\ The foregoing instrument� was acknowledged this Z ef day of I Y\at f ,20 , by i♦ .. ( V `e • _who personally appeared before me and (printed nam- • Permittee) _�<+`'. c; TONT GfNDLESPERGEP, ackn. .ged t - •e/s' : signed t e instrument voluntarily for the purpose express,I n i .• MYCOMhdISSION#GG 353178 3. lk lir u �`.•' EXPIRES:October 6,2023 °`" Bonded Thru Notary Public Underwriters AP ...... ei [ ]Personally Known Signature of Notary Public,State of Fled a [ ]Produced Identification(Type) H:\Applications&Forms\Word Documents\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18 UUVHL L.UUN I Y / ana acceptea on �L! r >t • • \F-9so • a• 5'6S49O,,O F9 � 9 � \ Q 11 a' r� " `oma ti�� �o.; q ���� '` eico„ 4 ilifi"ii t _ *,.... . O /. I . tr\.• (1...(4.// i n O ti _k; b s. F _,x,,ii'V d; O 2 itili ' ir .- ,..._ 'Pt), / r S�<'C '. i `s' J"r x' ��-uo>/ 0.i? 454 6,OFF 1�w eo*es 0 ''' 'S. ..f-•'+e9f#ei; • O \ (�o�o� ((� 'r 4/0-6,,, 4) �` ' C' ttF O Vti ��� 01oh ''� 4*.SSti . ti Q • a s ��09. 70 ` R o,. V Q v�o O/45 6 �"s•-. �I NNO7727. 55. OF Ozp •yo:✓P 407'467 �(�cFiP COTe OFOl 4 V‘ N o? C p rh' - " L9 T 45? SURVEYOR'S NOTES: 30 1 FENCE OWNERSHIP NOT DETERMINED. CO746. GRAPHIC inc SURVEYORS CERTIFICATION: POINTS OF INTEREST: NONE VISIBLE yF,vvb _J.••SC;i�•,. I hereby certify that this Survey of the lands described was made my direct 4%�`G�.sSE Nl/,ye�,p\� supervision,andrto the best of myrknowledge • 6132 and belief is a true and accurate representation • ; of said lands and meets the Standards of / Practice set forth in Chapter 5J-15.050 through lek '�""' ""�, �Cf4~' 5J-15.053, Florida Administrative Code, C �/ –�` .., y:' pursuant to section 472.027, Florida Statutes. 3./tA t A fc,:, •.q`;' This survey is not valid without the signature and iiir Lard Surveyors,LLC 'Fs. STATE OF .4.1-," original raised seal of a Florida licensed surveyor , d+.. FLORIDA !p�; • $• and mapper,except when the electronic •;4, SURVEta•' signature and seal of a Florida licensed surveyor RAYMOND J. SCHAEFER and mapper is affixed hereto. Florida Land State of Florida Processional Surveyor and Mapper — = r e.Ass©c! License Number LCI _F LTA. 5132 Exaw Land Surveyors,LLC I U3i 8291 !T, - , r