289 MAGNOLIA ST ROW Permit Attachment of for
Permit# issued 20 Atlantic Beach,FL 32233
Owner's Name: Property Address:
R.E. #:
1� UTT Lot#/Block
MAY 21
SM
Py —1 REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of 20
by Atlantic Beach, Florida, a municipal corporation organized and existing under the laws of the State—of
Florida, hereinafter referred to as "CITY" and 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 of the City of Atlantic Beach for the purpose as described in the City of Atlantic
Beach Right-of-Way/Easement permit numbers e(copies
This work is generally desciibed as: 7777;Z "
Any facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains
sub ect to relocation or removal on thirty(30)days notice by CITY to the USER, said notice to USER shall be
i
given by certified mail, return receipt requested, to the following address:
The depositing of said notice of cancellation in the United States mail shall constitute the notice of
cancellation 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
exercise of the privilege herein granted and shall at all times maintain said facility in good and safe condition.
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 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 fi-anchise 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."
Pagel of2
The USER, prior to making any changes from the approved plans and/or in od, must obta en
h ks Department, for said change. The USER shall,at the
approval from the City of Atlantic Beach,Pub c Wor Oth in writt
discretion of the CITY, be requested to submit as-built
after the day of completion. drawings showing the change within thirty(30) days
This permit shall insure to the benefit of, and be binding upon, the USER and their respective succ
assigns. essors and
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 public
rights-of-way and other public land. USER fin-ther agrees that the CITY and its officers and employees shall
be saved harmless by the USER from any of the work herein under the terms of this permit and that all of said
liabilities are hereby assumed by the USER.
DATED and SIGNED this day of
By:
QProperty�Own�er
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this q:?/ day of"
411 20),15personally appeared before me, a Notary Public in
and for said County State, the property owner of
Atlantic Beach, Florida,known to me to be the person(s)described in
and who e cuted the foregoing instrument; who acknowledged to me that he or she executed the same freely
and vo Y fo the uses and oses therein mentioned.
oses th ntioned.
L
py" Notary Public State of Florida
;1 1-0
Notary Pu c in for said ounty and te y Shirley L Graharn
My Commission FF 086990
ExP'rQ*02/14/2018
CITY OF ATLANTIC BEACH, FLORIDA, a
municipal corporation:
Approved:
Doug Layton,Public Works Director
For Permits where city sidewalk is impacted,
City Manager approval required:
Nelson Van Liere,City Manager
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