855 Sailfish Dr fence permit ACH
CITY OF ATLANTIC BE
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
FENCE WALL OR BARRIER - FENCE
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: FNCE17-0019
Description: install 6-foot wooden fence
Estimated Value: 1000
Issue Date: 7/13/2017
Expiration Date: 1/9/2018
PROPERTY ADDRESS:
Address: 855 SAILFISH DR
RE Number: 1712460000
jj6PERTYOWNER:
Name: Dominant Assets LLC
Address: 1148-B Fmit Cove Road
St. Johns, FL 32259
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: XL PROPERTIES & CUSTOM
Address: 1144 FRUIT COVE RD DEVELOPMENT LLC11333 HIDEAWAY
DRS
JACKSONVILLE, FL 32259
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500.For HVAC work,a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
City of Atlantic Beach APPLICATION NUMBER
?\1 Building Department
lTo be assigned by the Building Department)
800 Seminole Road
Atlantic Beach,Florida 32233-5445
Phone(904)247-5826 Fax(904)247-5845 Date routed:
E-Mail: building-dept@coab.us
Cityweb-site IMPH�x0ab-us
APPLICATION REVIEW AND TRACKING FORM
sock l, De rtmem:rrs�wew required Yes No
Property Address: � ,�dTg
Applicant: Xll- Df Q.(L`-�� -*- CAt-S'6M PI6nmn6 &Zonin—IL>
Tree Administrator
Project:
_�Iu�ci�
Pultpz ty
Fire Services
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 Man
Amy Corps of Engineers
Division of Hotels and Restaurants
ivision of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: E]Approved. ElDenled. E]Not applicable
(Circle one.) Comments:
(:BUILD�1 �)
PLANNING &ZONING Reviewed by.—Date:—
TREEADMIN. Second Review: Approved as revised. ElDenied. E]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by:— Date: 6-6�12
FIRE SERVICES Third Review: E]Approved as revised. 013eniedV. ffNt applicable
Comments:
Reviewed by: Date:—
Revised 05119IM17
Fg FTY OF ATLANTIC BEACH
800 Serninole Road
MAY 3=1 20 7 Atlantic Beach,Florida 32233
17
Telephone(904)247-5800
FAX(904)247-5845
REVISION REQUEST SHEET OR OFFICE COPY
CORRECTIONS TO REVIEW COMAIENT
Date: ?�mA (eA17 Received by: Resubmitted:
Permit Number: f(J iff�r3 —Do Ic?
Ongmal Plans Examim: Project Name:
Project Addresq-
Contractor: XL lei Contact!Tal: em 0
Contar't Pho : Contact e-mail: )LL WAC&9M&L�,&�J
��Pl Check/Permit Fee(s)Due: $_5�0, 00
Desert oposed Revision to Existing Permit:
LSC441�J 1)9444-4�,r 7-D A06d lee,(VC Y
Additional Increase in Building Value: $ Additional S.F.—
Site Plan Revised: Public W U Approval:
By signing below.I(P;nt:R�J ty,14oy 014.0 affirin that the above revision
is inclusive of the pro ges.
1,7
Signature of Contracto<�A�,rsctsr m�sip if in�e in valuation) Da�
Ufis�UseOnly
DaM 6 - 6 , App—d—A— Rcf.�d: Notifisd by
Plan Review Comments:
Ale)�,'(?e C-0,4 1r*C/001L 2LV P/dc �f _'r4 C-0,0/ ply�_
;De P6 artment review required Yes No
D f"y
T Tree Administrator Plans Examiner
P PU61ic 6 6 1
blic UtilitFa��
ublic Safety
Fpi'lllre Services Date
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
�'J 80 Seminole Road
0
Atlantic Beach,Florida 32233-5445 FN C&I
Phone(904)247-5826 - Fax(904)247-5845
-dept@coab.us OS I 161111
E mail: building Date muted
Cityweb-site hftp/l..coab.us
APPLICATION REVIEW AND TRACKING FORM
Property Address: Tsls- SAW�'S�) Of. Department review required Yes No
-Wilding
< c
Applicant: X L Of op u O-QS'tory) tr3mqrj � Pl6innind &Zonffi�'�
I ree Administrator
Project:
_public Rilities,
Public Safely
Fire Services
Review fee Dept Signature
Other Agency Review or Permit Required Review or Receipt
of Permit Verified By Date
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaumn—ts
Division of Alcoholic Beverages and Tobacco
Other.
APPLICATION STATUS
Reviewing Department First Review: AApproved. E]Denied. []Not applicable
(Circle one.) Comments:
BUILDING
PLANNING&ZONING Reviewed by.A..,= Dat.5-/2-3 0-C-0
TREE ADMIN. Second Review: Pipproved as revised. [—]Denied. E]Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed b/ Date:;/—'5y2—'L2
FIRE SERVICES Third Review: E]Approved as revised. 00enied. E]Not applicable
Comments:
Reviewed by: Date:
R.vi..d 0511912017
D ECEOVE OF ATLANTIC BEACH
800 Seminole Road
MAY 3 1 2017 Atlantic Beach,Florida 32233
Telephone(904)247-5800
FAX(904)247-5845
;JJ9
REVISION REQUEST SHEET OR
CORRECTIONS TO REVIEW COMMOENT
Date: YIM46P317 Received by: Resubmitted:
Permit Numbev ft1C(-,(3 —bL7 lic?
original Flans E m ProjectName:
Mm
ra
XaL -Pr
Project Address:
Contractor: LklKjA) Contact Name fit I
e-mail: f-LClfJq0Q
Phone : WY 5&A 76 Contact
WSJ��Plan Check/Permit Fee (s) Due: $
I of Pro osed Revision to Existin permit.
&�dele t4c 7-V A46J
Additional Increase in Building Value: $ Additional S.F.
Site Plan Revised:
Public W U Approval-
By signing below.I 0.iffitn affirm that the above revision
is inclusive of the prop, hanges.
Signature of'Contracto'(Z.�.W. sisn if i�me in valwtion) Dj—
Daft: Appw�. Rq�: Notified by
Plan Review Comuumts�
De Ed artment review re uired Yes No
lt�n
64�&zonwng-j
Tree Administra or Plans Examiner
Public Wor a
ublic U ilities
Public Safety
Fire Services Date
City of Atlantic Beach APPLICATION NUMBER
Building Department (To be assigned by the Building Department.)
Atlantic Beach,Florida 32233-5445 -FN C&I-J -()(D I C,
800 Seminole Road "v 22 2017
Phone(904)247-5826 Fax(904)247 5845
E-mail: building-dept@coa1b.us Date muted: o
City web-site: http//www,ccab u s
APPLICATION REVIEW AND TRACKING FORM
Property Address: li-s's- S196k C�) 0 If. D rfin nt view required Yes No
Applicant: X L Of D�,04 rl -STEd-ing _lL>
Pl9nnin§&n_in
Tree Administrator
Project: J-`l WDDaLn"Lo
Public Utilities
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 Enyronmental Protection
Florida Dept of Transportation
St.Johns Riverwater Management District
Amy Corps of Engineers
Division of Hotels and Restauran��
DiMsion of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: gApproved. E]Denied. []Notaipiplicalble
(Circle one.) Comments:
BUILDING
PLANNING &ZONING Reviewed b�: Zzdxz&a,*� Date:�,—_-249
TREE ADMIN. Second Review: E]Approved as revised. DDenied. []Not applicable
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: E]Approved as revised. []Denied. E]Not applicable
Comments:
Reviewed by: Date:
Rwised 051191017
D EDEO VE TY OF AnANTIC BEACH
800 Seminole Road
MAY 3 1 2017 Atlantic Beach,Florida 32233
TelePhone(904)247-5800
FAX(904)Z47-5845
REVISION REQUEST SHEET OR OE'CEIVE
CORRECTIONS To RmEw COMMENT
Date: 4�'A 17 Received by: . 11 JON 0 2 2017
Pentrit Number: f , —bL7 Resubinitted: 3-Y,
Original Plans Exan"bun: Project Name:
Project AddressF,,V E
Contractor: 6
XL -W ry O'by Pa" Contact Naine
CoWaptPhorbe , W5� 50d- 76V Contact e-nWI:
I'lan check/Permit Fee(#Due: $
n1
7-V A16d y
Additional Increase in Building Value: $ Additional S.F.
Site Plan Revised: Public W U Approval-
By signing below I(;nt. LVAIA-Y 014A4d
is inclusive of thc*pro anges. affm that the above revision
Signature ofContractonq_.4��ft�rwt.jp if j..�,b,
D.ft: Ap._,a kq�dd:- Nofifi�by.
Plan Review Cornments:
Department review required Yes No
d
U11din — I
nin &Zoning
Tree Administra or Plans Exanniner
Pu He We s
ublic U ilifies
Public Safety
Fire XSewices Date
City of Atlantic Beach APPUCATION NUMBER
Building Department be assigned by the Building Department)
800 Seminole Road
A
Atlantic Beach,Florida 32233
Phone(904)247-5826 Fax
'-s'MAY 22 2017 Date muted: Ds (I
E-mail: building-dept@coab,u.
Cityweb-site hltp//�.cciabms
BY.
APPLICATION REVIEW AND CKING FORM
Ss- soct D��arntme t '
Property Address: t n review required Yes No
in.
Applicant: XU pf oi�D4-�E -4- eq�N�bm 0��qri 1 ding
PWnnin6&Zoni2��
I ree Administrator
Project: o am �k b_�� ;PU
.
Public Safely-
Fi�re Services
Review fee $ Dept Signature.'
_70--_
Other Agency Review or permit Required Review or Receipt
of Permit Verified By Date
Florida Dept.of Environmental Protection
Florida Dept.of Transportation
St.Johns River Water Management District
Amy Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPL!PATION STATUS
Reviewing Department First Review: Fe KApproved. ElDenied. E]Notapplicable
(Circle one.) Comments:
BUILDING
PLANNING&ZONING
Reviewed by:=4��5� '11/4—Date:
TREE ADMIN. Second Review: ElApproved as revised. ElDenied. E]Not applicable
PVCWO Comments:
_ �OKS
rPUBLIC UTILITIES
�T--z Z--r-)
PUU2BUC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: ElApproved as revised. ElDenied. EINot applicable
Comments:
Reviewed by: Date:
R.�is.d 05/1912017
D Y OF ATLANTIC BEACH
800 Seminole Road
MAY 3 1 2017 Atlantic Beach,Florida 32233
Telephone(904)247-5800
FAX(904)247-5845
REVISION REQUEST SHEET OR
CORRECTIONS TO REVIEW COAVdENT JUN 0 2 2017
Date: TIM4 Aa, Received by:
ema Resubmitted:ft—
P tllum�br3 bolcl
Original.Flans Examin r: Project Name-
aram
Project Addrcss:
Contractor:
Contact Name�—,
mim;tPhone : Contact e-mail:
Plan Check/Permit Fee(a)Due:
i of Pro ed Revision to Existin Permit.
ELA�e Lac
A(�I/ y
Additional Increase in Building Value: Additional S.F.
Site Plan Revised: Public W U Approval-
By signing below.I(printn A allmn that the above revision
is inclusive of the prop hanges.
Signature of"ContracteV
DW!—
APP�A� Reje�;
Notiflul by:
Plan Review Comments:
JkEe lfft4-�1121') 5 c-01-7�0 oO'Va
ai� /V LA
t
/K ,k V X�L'Lc
De artment review re uired Yes No
u din
in &Zoning
Tree Administra or Plan;Exammer
Pub ic;Works
ublic U Mile 616117
Public Safety 4-7-0
Fire Sermices Date
CITY OF ATLANTIC BEACH
800 Seminole Road
�71 Atlantic Beach,Florida 32233
0 JIJN 0 7 2817 1 Telephone(904)2,47-5800
b Y. FAX(904)2,47-5845
r
REVISION REQUEST SHEET OR
CORRECTIONS TO REVIEW COMMENT
Date: Received b�y: Resubmuted:
Original Plans E Project Name:
Project Address;::JZ5-- ?a 2-7--?
ContractorK LON6—!b�o A�o &A hym 0 Clio A,1 Contact N;e, CLZao
ContactPhonse : �&,� 10.z 7693 Contact e-mail:
Revision/Plan Check/Permit Fee(a)Due: $ CL-4
Desciription of Proposed Revision to Existing Pernait:
Additional Increase in Building Value: $—. Additional S.F.
Site Plan Revised: Public W U Approval:_
By signing below.I(print name)— �AAIJ,4d4f n JZ�tO affirm that the above revision
is inclusive of the proposoleir--les.
pp/ 7
Signature of Contractor QLent�, mmutor must sip if�in=%a in valuation) Dti
Date Appmvtai� rk'4A Rejeomd: MOM by:
Plan Review Cormuents:
w-z�r�z -"KPA&VA-L--
Department review required I Yes No
Building
Planning &Zoning
Tree Administrator Plans Examiner
or a
Ifflifia'14: — — �/,/(7
ublic Safety/ I
Fire Seuvices,xw Date
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
oil OFFICE COPY (904)247-5800
BUILDING DEPARTMENT REVIEW COMMENTS
Date: 5.30.2017
Perm t#: I FNCE-001 -swe-Address. 1144 Fruft Cove Rd., St.Johns
e Address: 1855 Sailfish Dr., AB Phone: 904.502.7693,904.704.3777
Review: 11 Email: xlj)roviax(a),aoLcom
PJE#: 171246-0000 Homeowner: Dominant Assets,LLC;
billeirmo*,passportrealty.com
Applicant: XL Properties& Custom
Desipn
CORRECTION COMMENTS: These comments am from 1 of 4 departments that are
reviewing this application.
2 copies of legal survey, draw fence location on both surveys.
—Al
- lee C-
Mike Jones
Building Inspector/Plan Reviewer
City Of Atlantic Beach
800 Seminole Road
Atlantic Beach, Fl, 32233-5445
Ofc (904) 247-5844
Fax(904) 247-5845
Perrone, Jennifer
From: Moore, Kayle
Sent: Tuesday,June 06, 2017 8:15 AM
To: bilicirmo@passportrealty.com
Cc: Gindlesperger,Toni;Johnston,Jennifer: Perrone,Jennifer;Williams, Scott
Subject: Revocable Encirceichment Permit for 855 Sailfish Dr
Attachments: Revocable Encroachment Permit(20.04.2017).pdf
Mr. Cirmo,
The fence being permitted at 855 Sailfish Dr. in Atlantic Beach will be located in a utility ea�ment along the east and north property
line. The City currently owns and maintains active undergmund utility lines within this easement. As a result,the City will need you be
submit a completed Revocable Encroachment Permit application(see attached)to the PermitUng Department at City Hall,
This will allow Public Utilities to sign off on your approved fence permit for this property.
You may contact me via email or at 904-247-5834 if you have any questions regarding this request.
Sincerely,
Kayle
-----------------------------------
Kayle W. Moore, P.E.
Public Utilities Director
City of Atlantic Beach
(904)247-5834
kmoore@coab.us
Building Permit Application
city of Atlantic Beach OFFICE COPY
800 Seminole Road,Atlantic Beach,FL 32233
Phone:(904)247-5826 Fax:(904)247-5845
JobAddress: eg�-S41(Anf pe 46 D.Ij 3 —Permit Number: F/J C& 1-f 0 19
LegaiDescription- 3Q-660 ROYC9910 Y"Jil-1 RE# /'71 ? '1- 6 - ()
Valuation of Work(Replacement Cost)$ /000 or Heated/Cooled SF_4K_Non-Heated/Cooled
• Class of Work(Circle one): 69)Addition Alteration Repair Move Demo Pool Window/Door
• Use of existing/proposed structure(s)(Circle one): Commercial 41Z�
• If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No 4F)kl)
• Submit a Tree Removal Permit Application if any trees are to be removed or Affidavit of No Tree Removal
Describe In cleMll the type of work to be performed: �rjj�14 f(_ 6 ' H9t 614ir warop t7'),
P(ZI ')+t y Fri-ee 0--� J;q2oA-?F/ 6,0 r# ,r,pes 'qw P'e'o-,t ')F PlUe'Lry I
Florida Product Approval# for multiple products use product approval form
Prowrin,Owner Information
Name 00m'�)4�f- 4'rferf t� Address: 11YU11
city jT_ Stale /�Y- zip
E-Mail A UA'q J4C'4lj:)if' COM
Owner or Agent(If Agent,Power of Attorney or Agency Letter Required) OWAA&Z.
Contractor hinfirtrimation
Name of Company: v- I/Allegic cwrw 446)Clualify�ao Agent: )(441`4C 'Pj(46CAh
Address fift rj&'C COUL " city-JEJ-hatnul state Fe- Zip_3jAj'?_
Office Phone 90 r- 50d-7/_9� Job Site/Cont Number YOV- 70 Y- 3'72Z
State Certification/Registration# e6c. /57 7?42 9, ev_ 40 4- CoA4
Architect Name&Phone#
Engineer's Name&Phone 4
Workers Compensation
E�Pt/Insumr/UraseE r.
0
Application is hereby made to obtain a permit to do the work and installa I indicated.I certify that or installation has
commenced prior to the issuance of a permit and that all work wrill be pe to legloa so I laws nagulationg
xtt ta
construction in this jurisdiction.I understand that a separate permit mus urey ror EL R 0 MIRING,SIGNS,
RS RS
WELLS,POOLS,FURNACES,BOILERS,HEATERS,TANKS,and AIR CONDITI
a It
OWNER'S AFFIDAVIT:I certify that all the foregoing information is accura teand that all work will be done in co pliance with all
applicable laws regulating construction and zoning.
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 FINANCIP 0 SUILT WITH YOUR LENDER ORAN TTORNEY
�OU ±,. C N ATTO!NEY BYFORE
RECORD I OF COMMENCEMENT.
CORD OU OT' OF Cor'
(Slgmtu f ror nt including Conterictorl SI a of Contractor)
Sign d and sw t or med)before me this��day of Signe d swom ed)before me this 5- day of
C)
riture
4k �O 1-1 Y J\2 �O k-\ by �c,c
(Signature of Nottary) (Signature of Notary
or
JESSICA SMIT
C ssiob#F�F 905104
ornmi JESSICA SMITH
Contranisson#FF 905104
"i-sonally Kno EXbimockberl,2019 Kin n OR
.�TWMFO�iw_zq rsonalky V Expires October 7,2019
�n OR , e. ot
I Produced Identification Ev-12: Produced Iden7
Type of Identification: Type of Ident....a t..
>- a)
(L
0 CODE COMPLIANCE
L) i=L) FOR BEACH
CITY OF ATLANTIC
Ul
SrE PERMITS FOR ADDITIONAL
EL -it REQUIREMENTS AND CONDITIONS
LL. �o V OATE%-��')
0 REVIEWED BY:
c
if
Z�21
.00 3. 'Be
4.0
3g ts
rLt
0
16 Ir m at 5
ow
No
R.O.W. Permit Attachment of for
R.O.W. Permit# issued 20— Atlantic Beach,FL 32233
Owner's Name: 'Nno*�r A�,rru-s 1-4- c-
Property Address: Aithrig M�\, &-fnd :?aM-3
Subdivision: Y& &2e4 R.E.#: 1712�(6 &)00
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of
20a by Atlantic Beach, Florida, a municipal corporation organized and existing
under the laws of the State of Florida, hereinafter referred tow"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/Easernent permit numbers noted above(capies attached).
This W rally described as: -774-f or � v,,I ttoo ,
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, mid notice to
USER s,
%,,�yalfied 1� e following address:
V_e
�,th
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 my and all necessary repairs to my 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 die City's approved representative or other fi-anchised
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 I of 2
The USER, prior to making any changes ftons 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 die benefit of, and be binding upon, the USER and their respective
successairs;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 linsitations/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 my 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. 167day,f 20LZ.
By:
rty r
be si in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this (a day of 21_L-
14, :_I- Ae=liy appeared before me, a Notary
Public in and for mid County and State, 5� I the property owner of
955 s4&_ I Atlantic Beach, Florida, known to me to he 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.
&11�wc in for said County and S HARRY L CROWELL,JR.
l Karl,Public-State of Florida
Commission#FF 960292
My comm.Expires Feb 28,2020
Bonded though National Nsffy Assn,
WBy -- 7—
be7i nillresence of the I
:N';'m
iiis' lrw
CITY OF ATLANTIC BEACH,FLORIDA,
a municipal corporation:
Approved:
Soottwilliams- '
Public Works Director
File: 12112/16
Page 2 of 2