1800 Live Oak Ln Parking for driveway 2012 City of Atlantic Beach APPLICATION NUMBER
Building Department o be assigned by the Building Department.)
800 Seminole Road
Atlantic Beech, Florida 32233-5445 V61 M Ld ' 9�110
Phone(904)247-5826 - Fax(904)247-5845 -71
Date routed:
E-mil: building-dept@wab.us
Cilyweb-sita! htlp!/A~ewb.us
APPLICATION REVIEW AN'l TRACKING FORM
Property Address: Aft- Department review required Yes- No
Building
Applicant: Planning&Zoning
Tree Administi-ator
Project: �:;Fublic Wo
-Public Utilities
Public Safety
Fire Services
Other Agency Review or Permit Required Ri view or Receipt Date
of F lermft Verified By
Florida Dept.of Environmental Prolection
Florida Dept.of Transportation
St.Johns River Water Management District
Army Corps of Engineers
DiWsion of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other
APPLICATION STA�TUS
Reviewing Department Fimt Review: ElApproved. E]Denied.
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed t I�y: Date:
TREE ADMIN. Second Review: FlApproved as revis�. FIDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed 0y: Date:
FIRE SERVICES Third Review: []Approved as revis []Denied.
Comments:
Reviewed t�y:_ Date:
Revised 07127110
CITY OF ATLANTIC BEACH
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
800 Seminole Road 904-247-5800
Atlantic Beach,Florida 32233-5445 Fax 904-247-5845
PLEASE SUBMIT(3)COMPLETE SETS OF PLANS WITH APPLICATION.
Date
PERMIT#
Z ISSUED BY THE CITY
Jo b Add res 1—i-1V1 Ll)d Ay__ Z-7?
Permitee: Telephone#
Permittee Address: 4,0,0 zl-vi
Requesting Permission to Construct: 1*2f �'77 /fed &111-4 -
Z 4 4 d 4
4�
Location: (Reference to Cross-Street)
1. Applicant declares that prior to filing this applicabon he has ascertained the location of all existing utilities,
both aerial and underground and the accurate locations are,shown on the sketches.
A Letter of Notification was mailed to the following Utilities/Municipalities:
Jacksonville Electric Authority Yes No ate:
Bell South Telephone Company Yes (�) N Date:
Ferrell Gas Yes o Date:
Y
Comcast V, No Date:
2. Whenever necessary for the construction, repair, improvarrient, maintenance, safe and efficient operation,
alteration or relocation of all, or any portion of said street or easement as determined by the Director of Public
Works, any or all of 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 Director of Public Works, and at the expense of the Permittee unless reimbursement is
authorized.
3. All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be
performed under the supervision of (Contractor's Project
Superintendent) located'at Telephone
4. All materials and equipment shall be subjectto inspection $y the Di ctor of Public.Works or his designee.
5. All city property shall be restored to its original condition ao far as practical, in keeping with city specifications
and the manner satisfactory to the city. i
6. A sketch of plans covering details of this installation, as v I�ell 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. 1
7. This permittee shall commence actual construction in good faith with days. If the beginning date is
more than 60 days from date of permit approval, then pe-mittee must review the permit with the Director of
Public Works to make sure no changes have occurred in tf e area that would affect the permitted construction.
8. It is understood and agreed that the rights and privileges ierein 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.
9. The Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again
immediately upon completion.
OWNER
Signe Date:
Bef X9_m2_e this d i tha I lip,
Sta nall p ared SHRLEY L GRAHAIJ
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M� P bll� S te o Flor a,Co of Duval. my COMMISSION 9 DC 967760
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