255 PINE ST REP 1'
r
ermit Attachment of for
ermit# issued ,20_Atlantic Beach,FL 32233 J U L 14
Owner's Name: Property Address: 2�' / g _
R.E. #:00 fit'?
Subdivision:._s���,,L Lot#/Block#: L o 7-
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,
he einafter referred to as"USER".
WITNESSETH:
Th t 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 noted above(copies attached).
This work is generally described as:Act
--s.`'C' ie�Pcrla !'�axe �rn+ nrT/0 `(
An facility maintained, repaired, erected, and/or installed in the exercise of the privilege granted remains
subj ct to relocation or removal on thirty(3 0) days notice by CITY to the USER, said notice to USER shall be
give 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
cant 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 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 franchise utility provider.
The &cilities 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 Gode Section 19-7(h)which states "Driveways that cross sidewalks: City sidewalks may not be replaced
with ther materials, but must be replaced with smooth concrete left natural in color so that it matches the
existing and adjoining sidewalks."
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z
The USER, prior to making any changes from the approved plans and/or method, must obtain written
approval from the City of Atlantic Beach,Public Works Department, for said change. The USER shall,at the
discretion of the CITY, be requested to submit as-built drawings showing the change within thirty(30) days
after the day of completion.
This permit shall insure to the benefit of, and be binding upon; the USER and their respective successors and
assigns.
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 further 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 �V , 206
By. / / 2C
roperty Owner
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this� day of S
20L, personally appeared before me, a Notary Public in
and f r said-County and State, (�J�V� �t �
2 �. P 1J� ,Atlantic Beach, Florida�o known tome property owner of
escribed in
and who executed the foregoing instrument; who acknowledged to me that he o�hebe texecut d the he person(s) same freely
and voluntarily and for the uses and purposes therein mentioned.
='M', JENNIFER WALKERNotary Public In for said County and State I5510N#FF o11ae0ES;APdI 24,2017Notary Public Underwrite s
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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