65 SHELL REVOCABLE ENC Y ie
Zt Attachment of for
et# issued ,20 Atlantic Beach,FL 32233
wner's Name:m1 cy4t I t�` roperty Address:
.E.#: _� ---I—
Subdivision: Lot#/Block#:
REVOCABLE-ENCROACHMENT PERMIT
'ZC da
THIS REVOCABLE ENCROACHMENT PERMIT,issued on this y of 1� 20
b Atlantic Beach, Florida, a municipal corporation o aized and existing under the la sof the State f
Florida, hereinafter referred to as "CITY" and
hereinafter referred to as"USER". of Atlantic Beach; Florida,
WITNESSETH:
That the CITY does hereby grant the USER permission on a revocable basis as described herein the right to
enter upon the property of the City of Atlantic Beach for the
Be ch Right-of-Way/Easement permit numbers noted above(copies attachedse as )escribed in the City of Atlantic
This work is generally described as: P&V f
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 the USER, said notice to USER shall be
given by certifies m�L retu� receipt requested, to the following address:
The depositing of said notice of cancellation in the United States mail shall constitute the notice of
can llation and the burden is upon USER to keep the CITY informed of USER's proper address.
The USER shall promptly make any and all necessary repairs to any facility erected or maintained in the
exer ise of the privilege herein granted and shall at all times maintain said facility in good and safe condition.
In th event it is necessary for the CITY or the City's approved representative or other franchised utility to
enter upon the above-described property of the CITY, the USER shall replace at the USER's sole expense,
any aid all material necessarily displaced during the action of maintaining, repairing, operating, replacing, or
addin 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 pevelopment Code, and all other land use and code requirements of the CITY,including
City ode Section 19-7(h)which states"Driveways that cross sidewalks: City sidewalks may not be replaced
with c ther materials, but must be replaced with smooth concrete left natural in color so that it matches the
existir g and adjoining sidewalks."
Page 1 of 2
The USER, prior to making any changes from the a
approval from the City of Atlantic Beach,Public Works Department, for said change.
discretion of the CITY, be requested to submit - approved plans and/or method, must obtain
written
after the day of completion. as built drawings showing the change within USER
shall, d the
This permit shall insure to the benefit of, and be binding upon; the USER and rtY(30) days
assigns. their respective successors and
SER shall meet the terms and conditions of this permit and to all of thea applicable d/or specifications, to include utilities locate requirements and use limitati
'ghts-of--way and other public land. USER pp cable State and CITY laws
e saved harmless by the USER from U Ru ther agrees that the CITY and its officers and employ eents of mployees
1 abilities are hereby assumed by the SER.f the work herein under the terms of this permit and that all of said
TED and SIGNED this 22rUk '
—_day of I 20 I
ye
►Bner
gnein presence of the Notary)
TE OF FLORIDA
C LINTY OF D[TVAL
On this 2�r of ,I S
an for s id County and St '�) erso�ally,rayared before mf ate, � e, a Notary public m
and ho executed the foregoing ms 'Atlanthe
tic Beach, Florida,known to me t er of
be the Person(s)deProperty scribed m
g g Purpose who acknowledged to me that he or she executed the same freely
and oluntarily and for the uses and purposes therein mentioned.
Nota Public in for said County and State
CIT OF ATLANTIC BEACH, FLORIDA, a
municipal corporation:
Appr ed:
Doug ayton,Public Works Director
For Pe its where city sidewalk is impacted,
City Manager approval required:
Nelson an Liere, City Manager
Page 2 of 2
i -