1757 ATLANTIC BEACH DR - BACK SIDE OF REVOCABLE 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.
iDATE P r• NED this (J day of ollm DP 2. , 2005
By r t• L____
Pr, r
• • signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this (. 11-%day of INC9 Qnth .( , 2005 personally appeared before me, a Notary
Public in and for said County and State, Chr i 5 (J)c .c , the property owner of
(l'5' A+lowfie. emu, Dr . , Atlantic Beach, Florida, known to me to be the person(s)
described in and who executed the foregoing instrument; who acknowledged to me that he or she
executed the same freely and voluntarily and for the uses and purposes therein mentioned.
,t0°qo. Notary Public State of Florida
1 1 ?� Amber Atteberry IL �y� y,._ I My Commission EE 850279
• . . Public in • said County .'ate '4-a,„os Expires 11/08/2016
CITY OF ATLANTIC BEACH, FLORIDA, a
municipal corporation:
Approved:
Ricky L. Carper, Public Works Director
•
For Permits where city sidewalk is impacted,
City Manager approval required:
Jim Hanson, City Manager
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