418 SKATE RD - DRIVEWAY ,z. ' `' S, CITY OF ATLANTIC BEACH
-- ' j 800 SEMINOLE ROAD
!J' =" ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
J�
�J331��
DRIVEWAY PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-DWAY-3765
Job Type: DRIVEWAY
Description: REPLACE CONCRETE DRIVEWAY WITH PAVERS
Estimated Value: $5,400.00
Issue Date: 4/28/2017
Expiration Date: 10/25/2017
PROPERTY ADDRESS:
Address: 418 SKATE RD
RE Number: 171558-0000
PROPERTY OWNER:
Name: FORSYTH, ALLISON V
Address:
PERMIT INFORMATION: PUBLIC WORKS: UTILITY DEPT.:
Full erosion control measures must be installed and approved prior to beginning any earth disturbing
activities. Contact the Inspection Line(247-5814) to request an inspection from Public Works for
Erosion and Sediment Control Inspection prior to start of construction.
All runoff must remain on-site during construction.
Roll off container company must be on City approved list(Advanced Disposal, Realco Recycling,
Shapell's Inc.). Container cannot be placed on City right-of-way.
Full right-of-way restoration, including sod, is required.
Ensure all meter boxes, sewer cleanouts and valve covers are set to grade and visible.
A sewer cleanout must be installed at the property line. Cleanout must be covered with an RT1
concrete box with metal lid. Cleanout to be set to grade and visible.
FEES:
Fence/ROW $35.00
PERRII"IIS APPROVED ONLY IN ACCORDANCE 11'I Ill :ALI. C1'1'1' OF A I,:1N l IC BEACH ORDINANCES AND TIIE FLORIDA
BUILDING CODES.
Ili-
4 �
1 J'j
.,,, ' , CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
\_\,,),
_ � ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
UTIL REV RESIDENTIAL BLDG $25.00
Total Payments: $60.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
rsLivps, City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
s so
• 800 Seminole Road /�
Atlantic Beach, Florida 32233-5445 17— (W Pc� 37�C.J5
Phone (904)247-5826 Fax(904)247-5845
0.210 E-mail: building-dept@coab.us Date routed: /�—T / c /
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 4 l Ej S < c I `` Si Department review required Yes No
Buildin•
Applicant: W N G Planning &Zoning
Tree •minis ra or
Project: RVcR �` RiV E(,O ublic Works
Public Utilitie
t e• t l J&AAA Public 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 Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: Q pproved. Denied.
(Circle one.) Comments:
:UILDIN 0 ci
PLANNING & ZONING Reviewed by: Date: � '�G'1 7
TREE ADMIN.
Second Review: ElApproved as revised. ❑Denier
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
Revised 05/14/09
ot.-vpr,,., City of Atlantic Beach APPLICATION NUMBER
; Building Department
j `;` 800 Seminole Road (To be assigned by the Building Department.)
� Atlantic Beach, Florida 32233-5445 17- (� A) K1/_ 37
Phone(904)247 5826 Fax(904)247-5845 t
>? E-mail: building-dept@coab.us Date routed: 4 / i et / 17
City web-site: http://www.coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: 4 ` E Sid RAim Department review required Yes No
�Buildin.
Applicant: () N GK_ Planning & o
Ti"--7;-7kdminis rator
Project: I \./ R RivEGO r.. .
'u. is utilities
RC—,move e o,.•,e, lD,Z
lV e ' 7, Public 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 Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
I
Reviewing Department First Review: ,Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING
Reviewed by: iti.�.�� � s _ Date: `///ar!!7
TREE ADMIN. Second Review:
Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: DApproved as revised. ❑Denied.
Comments:
Reviewed by: Date:
evised 05/14/09
0!...e prir, City of Atlantic Beach
Js ECE� APPLICATION NUMBER
' 1 Building Department
800 Seminole Road assigned by the Building Department.)
Atlantic Beach, Florida 32233-5445 1I 7- (�� ��-/_ 37/��''
Phone(904)247-5826 • Fax(904)247-5845 1 4 t01 ` `�
.4Zofii.0 E-mail: building-dept@coab.us Da routed: 4 f , 1 17
City web-site: http://www.coab.us BY'
APPLICATION REVIEW AND TRACKING FORM
Property Address: 4 t V Sts (1 Department review required Yes No
�uildi
Applicant: () 1/v N GP_ arming &Zonm
Tree Administrator
Project: Iih t 4 V Gly : • 'ublic Wor s
Public Utili i-
R C-,✓1n OV e- ar)Jv e, �tz.N evolki Public 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 Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: IVrApproved. ❑ enied. /Y/ /7
(Circle one.) Comments: 4€ IQ 64N64
BUILDING
PLANNING &ZONING `
Reviewed b.• i j/,y Date: f::•02 •-/7
TREE ADMIN. Second Review: []Approved as revised. ❑Denied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied.
Comments:
Reviewed by: Date:
evised 05/14/09
01.Aiptif.,. City of Atlantic Beach APPLICATION NUMBER
6 Building Department
r sd REC
E I assgned by the Building Department.)
800 Seminole Roada.�
ue y � Atlantic Beach, Florida 32233-5445 7 (- � �� 37
Phone(904)247-5826 • Fax(904)247-5845 APR 14 x.017 LI7-
��jja^"�o;310 E-mail: building-dept@coab.us Daouted: 4 / I et / ( 7
City web-site: http:/lwww.coab.us
BY•
APPLICATION REVIEW AND TRACKING FORM
. Property Address: 4 ` 8 S6 RA. De. - -nt review required Yes No
:uilding
Applicant: C) W (v GR_ _ = arming &Zoning
Tree Administrator
Project: 1 AVGR RR vec43A c° +w_>
n - u l: tiIitie
C
R ( n-c: e �Alv e, ID 12-c\J�tnYPI Public Safety
Fire Services
Review fee $ 21--
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 Alcoholic Beverages and Tobacco
Other:
APPLI ATION STATUS
I
Reviewing Department First Review: Approved. ❑Denied.
(Circle one.) Comments:
BUILDING
PLANNING &ZONING 4J
Reviewed by: Date: 7(7 t?
TREE ADMIN. Second Review: ['Approved as revised. ['Denied.
P , WORKS) Comments:
PUBLI�WTI E/,S7
PUBLIC
SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ['Approved as revised. ODenied.
Comments:
Reviewed by: Date:
II
evised 05/14/09
f.
- si;
= .., `� ATLANTIC BEACH DATE 4'- i5-
.4.
CITYOF
800 Seminole Road,Atlantic Beach FL 32233
":4-0.219}' Office:(904)247-5826 • Fax: (904)247-5845
Job Address: 11/ g k•cAte Pel Permit Number: 17-bV)Pt`f-37 -5
Legal Description 1-0 74 / S i3l o CJ - / Cr RE#
Valuation of Work(Replacement Cost)$ 674/6 G Heated/Cooled SF Non-Heated/Cooled
• Class of Work(Circle one): New Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercia RreidEiftial
• If an existing structure, is a fire sprinkler system installed?(Circle one): es o N/A
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe in detail the type of work to be performed: 4p/a`c_ ( .) is L',1 ✓ a(y an a/ $t 4...1-c..)G l t-S
�iY� faVC/Ls `J •
Florida Product Approval# for multiple products use product approval form
Property Owner Information
Name: . �dv1 UL, Fit4& Address: /7' 8 S€i t/a /" 'G✓i v(/t a .
City 11 u gl circ- kika c...t. Statd/ Zip 3,1 A`5 3 Phone 90 4 - 7-/m al-9 7-
E-mail afv,r S 19k O fig'. ao( .c evY\
Owner or Agent (If Agent,Power of Attorney or Agency Letter Required)
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND
TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT.
Contractor Information:
Name of Company: • - ' ing Agent:
Address: ity State Zip
Office Phone Job S. - ontact Number
State Certification/Registration# E-Mail
Architect Name&Phone#
Engineer's Name&Phone#
Worker's Compensation
Exempt / Insurer / Lease Employees / Expiration Date
Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced
prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction.
This permit becomes null and void if work is not commenced within six(6) months, or if construction or work rs suspended or abandoned for a
period o six(6)months at any time after work is commenced. I understand that separate permits must be secured for Electrical Work,Plummbbin:
Signs, Wells,Pools,Furnaces,Boilers,Heaters, Tanks and Air Condit:r r' e .
Signature of Prope , iinet-: . i 4 A ' A. . _i`. n/ S 1nature of Contractor: •
Befo
this ay of 4,4.• . A` , ? :f ape thi�ONl GINDLESPEROgy
vI 'l,;Y .„ MY COMMISSIONtrFF 924951of jw
o EXPIRES:October 6,2019
Notary Public: r w� .,,,z.,:-„,,,,,v, i lk•dThruNotary Public Underwrite4
dir
I hereby cert f'that I have read and examined this application and know the same to be true • d correct. All provisions of laws and
ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any other federal, state, or local law regulating construction or the
performance of construction.
Rev. 5/2/16
R.O.W.Permit Attachment of for •
R.O.W.Permit# issued ,20 Atlantic Beach,FL 32233
Owner's Name: � C�
Property Address: "/I ( �J S '(ci e. Rd
Subdivision: R.E.#:
REVOCABLE ENCROACHMENT PERMIT
�S REVOCABLE ENCROACHMENT PERMIT, issued on this /3." day of
tip t'I , 201 , 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 noted above(copies attached).
This work is generally described as: j0 /a-a2 w a -,,n� CLIA w c y c.
/m awwe._(Ai
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 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 franchise 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."
Page 1 of 2
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 inure 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 hereb assumed by the USER.
DATED and SIGNED this day of ,20 (7.
r
By: ` p1. 1,t 1
/ 49"/-1-
Property Owner •
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this I ) day of -j) e
� f�.` , 20 I personally appeared before me, a Notary
Public in for said o ty and State, , the property owner of
4 Eq.,*2 < , Atlantic Beac , Florida, known to me to be the person(s)
des •;d in and who exec ed the foregoing instrument; who acknowledged to me that he or she
ex, :. the - -ly and oluntarily and for the uses and purposes therein mentioned.
' 4111k elt-A
NotTry Public in for said Coun ?d State
r1=1
GINDI-ESPERGERMISSION#FF 924951ES:October 6,2019 ,ru Notary Putr5c Underwriters
CITY OF ATLANTIC BEACH,FLORIDA,
a municipal corporation:
Approved:
iiiiisii‘,(4,.4 .;. z_
Public Works Director
feet 11/40/
File: 12/12/16
Page 2 of 2
i
•
y . CITY OF ATLANTIC BEACH
0 WNER / BUILDER AFFIDAVIT
•
I. FLORIDA STATUTES; CHAPTER 489, FLORIDA STATUTES, PART 1 "CONSTRUCTION
CONTRACTING" REQUIRES OWNER/BUILDER TO ACKNOWLEDGE THE LAW:
DISCLOSURE STATEMENT FOR SECTION 489.103(7),FLORIDA STATUTES:
STATE LAW REQUIRES CONSTRUCTION TO BE DONE BY LICENSED
CONTRACTORS. YOU HAVE APPLIED FOR A PERMIT UNDER AN EXEMPTION TO THAT
LAW. THE EXEMPTION ALLOWS YOU,AS THE OWNER OF YOUR PROPERTY,TO ACT AS
YOUR OWN CONTRACTOR EVEN THOUGH YOU DO NOT HAVE A LICENSE. YOU MUST
SUPERVISE THE CONSTRUCTION YOURSELF. YOU MAY BUILD OR IMPROVE A ONE—OR
TWO FAMILY RESIDENCE OR A FARM OUTBUILDING. YOU MAY ALSO BUILD OR
IMPROVE A COMMERCIAL BUILDING AT A COST OF$25,000.00 OR LESS. THE BUILDING
MUST BE FOR YOUR USE AND OCCUPANCY. IT MAY NOT BE BUILT FOR SALE OR LEASE.
IF YOU SELL OR LEASE A BUILDING YOU HAVE BUILT YOURSELF WITHIN ONE YEAR
AFTER THE CONSTRUCTION IS COMPLETE, THE LAW WILL PRESUME THAT YOU BUILT
IT FOR SALE OR LEASE,WHICH IS IN VIOLATION OF THIS EXEMPTION. YOU MAY NOT
HIRE AN UNLICENSED PERSON AS YOUR CONTRACTOR. YOUR CONSTRUCTION MUST
BE DONE ACCORDING TO THE BUILDING CODES AND ZONING REGULATIONS. IT IS
YOUR RESPONSIBILITY TO MAKE SURE THAT PEOPLE EMPLOYED BY YOU HAVE
LICENSES REQUIRED BY STATE LAW AND BY COUNTY OR MUNICIPAL LICENSING
ORDINANCES.
II. INJURY LIABILITY; SINCE OWNERS MAY BE LIABLE FOR INJURIES TO WORKERS THEY HIRE,
THE BUILDING DEPARTMENT SUGGESTS WORKER'S COMPENSATION INSURANCE BE
PURCHASED.
III. IRS WITHHOLDING; OWNERS HIRING WORKERS BECOME EMPLOYERS AND SHOULD ALSO
OBSERVE IRS WITHHOLDING TAX AND/OR FORM 1099 REQUIREMENTS ON THE WORKERS THEY
EMPLOY ON THEIR IMPROVEMENT TRADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY
CIRCUMSTANCES. OWNERS BEING SUBJECT TO $5,000 PENALTY UNDER FLORIDA STATUTE NO.
455-228(1). AN"OCCUPATIONAL LICENSE"IS NOT ADEQUATE. THE OWNER SHOULD PHYSICALLY
SEE THE COUNTY "CERTIFICATE OF COMPETENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. TELEPHONE THE
BUILDING DEPARTMENT(247-5826) IF IN DOUBT.
V.ACKNOWLEDGEMENT; I HEREBY ACKNOWLEDGE THAT I HAVE READ THE ABOVE DISCLOSURE
STATEMENT AND THAT I COMPLY WITH ALL THE REQUIREMENTS FOR THE ISSUANCE OF AN
.OWNER-BUILDER PERMIT.
ADDRESS PHONE NUMBER
rfi ips , A LA--). Fal_a. ,„„,.... i
PRINT N•ME
i \'
.A --- k) A,SIGNATURE
1 DATE [ f 1
Before me this 13 day ofIf: M.. 201 n the county of
Duval,State of Florida,has personallyppeared herin by himself/herself and affirms that
all statements and declarations ar true(and accurate.
Notary Public at Large,State ofIL—( ,County of rt: (){fa..."
o Personally Known
❑ ( CI
_ C)
ProducedIdentificaGo - f! Irak.Irak. -�`• ,.0- .- V `-il
xr iy�,,�
TONIGINOLESPERGER
Notary Signature: `. .�Iw� ` ?�- ��.�'.
,= MY COMMISSI N#FF 924951
l� '•..•'o EXPIRES:October 6,2019
Sil •
,,,,(,.,
Bonded Thn,Notary Pubic Underwriters
F:BLDG1Owner•BuitderAll'edavit:REVISED:4p6/2009 - --
R.O.W. Permit Attachment of for
R.O.W. Permit# issued ,20 Atlantic Beach,FL 32233
Owner's Name:
r� C
Property Address: /1 � �J C--� "�-Q:.� e. ,
Subdivision: R.E. #:
REVOCABLE ENCROACHMENT PERMIT
,HIS REVOCABLE ENCROACHMENT PERMIT, issued on this /311/‘ day of
pri'I , 20 19-, 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 noted above(copies attached).
This work is generally described as: /`L"l ice c.w a cILLAifeitActy ce n d
a// .c Lat/d cv. f xif �
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 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 franchise 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."
Page 1 of 2
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 inure 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 hereb assumed by the USER.
DATED and SIGNED this ff day of ,20 l7
�r
By: il4JLJJ/ çl�
Property Owner •
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this I day of Ci- 1 201
, personally appeared before me, a Notary
Public in for said o and State, the property owner of
4« � . l �
q. e-. < , Atlantic Beac , Florida, known to me to be the person(s) -
des ;d in and who exec ed the foregoing instrument; who acknowledged to me that he or she
ex :• the ly and oluntarily and for the uses and purposes therein mentioned.
41i
r allik &
II
Notary Public in for said Coun 7-d State
'�'j ,, TONT GINDI-ESPERGER
0
?*. is ,r_ MY COMMISSION#FF 924951
a,;4.--, EXPIRES:October 6,2019
a'�'pF F `' Bended Thin Notary?ubric Under/inters
CITY OF ATLANTIC BEACH,FLORIDA,
a municipal corporation:
Approved:
Donald D.Jacobovitz,P.E.
Public Works Director
File: 12/12/16 •
Page 2 of 2
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AS RECORDED IN Pt AT BOOK 31 PAGES 16-160 OF THE PUBLIC RECORDS OF DUVAL COUNTY, FLOPIDA
CER77FIED FOR:ALLISON W. FOR,SYTH; HATHAWAY& REYNOLDS PA; CHICAGO TITLE INS CO.
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INE PROPERTY SHOWN HEREON APPEARS TO l �ON SAL
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