1979 Francis AT&T PW city of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
C)
800 Seminole Road
Atlantic Beach,Florida 32233-5445
Phone(904)247-5826 Fax(904)247-5845 Date routed
E-mail building-dept@coab us
City web-site http 11www,coab US
APPLICATION REVIEW AND TRACKING FORM
Property Address: rt :D::ejpa�rt�ment rev�iewreq�uired �Yes No
Build'
mg
Planning&,Zoning
Applicant: Tree Administrator
l)0Ckf,1CCA2L( 2e�l_ -
Project: Public Utilities)
IfuTli—c Safety
Fire Services
Review fee$ Dept Signature
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept.of Environmental Protection
Florida Dept of Transportation
St Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of AJcoholic Beverages and Tobaoco
Other
—.APPLlrATION STATUS
Reviewing Department First Review: 5ZA*pproved ElDenied
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Review:ed bty� tl�� I z__ Date:
TREE ADMIN. Second Review: ElApproved as revised A7191-nied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date.
FIRE SER\ACES Third Review: DApproved as revised. nDenied.
Comments:
Reviewed by: Date:
Revis*d 4=110
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CITY OF ATLANTIC BEACH
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
904-247-5800
800 Seminole Road Fax 904-247-5845
k- Atlantic Beach,Flonda 32233�A,15
Date 02/03/201.5 PERMIT
Job Address—Between FRANCI$AVE&.DUTTON ISLANQ RD E ISSUED BY THE CITY
Permitee. __Aj&j_ JOB#MAIN1.FRANCIS AVE Telephon A8NdATT&j-0M
-�irmittee Address�736 Mill CreeK Rd JACKSONVILLEFL 32211 AT7N,: SERGIO MARTINEZ
Requesting Permission to Construct- JOB*MAINT,..FRANCIS AVE PRQPOSLQ TO PLACE 224..FT OF BURIE12
SERVICE W H AS INDICATED ON DRAWINGS,USE C6$.L.1 MOT
,-IREAT24"MINDEPTI
Location (Reference to Cross-Street) FRANCIS AVE
1 Applicant declares that prior to filing this application 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,
TECO Yes(X) No Datei 02/03/15
Ferrell Gas Yes(X) No Datei Q2LQ3115
Comcast Yes(X) No Date:02/03/15
2 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 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 JEFF FENLON (Contractor's Project Superintendent) located at
11711-1 PHILLIPS HWY,JACKSONVILLE,FL 32256—Telephone# 904-263_-0361
4, All materials and equipment shall be subject to inspection by the Director of Public Works or his designee.
5� 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.
6, 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
7 This permittee shall commence actual construction in good faith with 60 days. If the beginning date is
more than 60 days from date of permit approval,then permiftee must review the permit with the Director of
Public Works to make sure no changes have occurred in the area that would affect the permitted construction
8, 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.
9 The Director of Public Works shall be notified twenty-four hours prior to starting work and again
immediately upon completion.
OWNER
Signed............... ...............— Date.
Before me this_day of_in the County of Duval,
State Of Florida,has personally appeared
Notary Publk,at Large,state of Florida,County of Duval.
My commission expires
Personally Known. of
Produced Identification.
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