583 COASTAL OAK LN - REVISION 7/26/17 OLA'%-tr� CITY OF ATLANTIC BEACH
l�''` f W�f 800 Seminole Road
". LL AAtlantic Beach,Florida 32233
J� 'L 2 7 2017 Telephone(904)247-5800
`3 13AM / V FAX(904)247-5845
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REVISION REQUEST SHEET OR
CORRECTIONS TO REVIEW COMMENT
Date: —1/d 11 Received by: Resubmitted:
Permit Number: 11C 5F2- a 9 3 o (l5-SFR-2355
Original Plans Examiner: Project Name:
Project Address: 583 God,sktAApa k L.
Contractor: OSS: Con ire-r., L CC Contact Name:
• Contact Phone : . Contact e-mail:
Revision/ Plan Check/Permit Fee (s) Due: $
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Description of Proposed Revision to Existing Permit:
L_. (‘(.4C))3'"Y\;%i4-3 t` oc_cW,e. y1 Crc)pt r_ Re ekit I ) C ` r
( i c prk' GO novs (-t 113/fl
Additional Increase in Building Value: $ Additional S.F.
Site Plan Revised: Public W/U Approval:
By signing below. I (print name) affirm that the above revision
is inclusive of the proposed changes.
Signature of Contractor/Agent(Contractor must sign if increase in valuation) Date
Office Use Only
Date: 7ii7i7' Approved: Rejected: Notified by: —
Plan Review Comments:
Department review required Yes No
Building ------ -
Planning &Zoning
Tree Administrator Plans Examiner
is Work 7,7 7 i7
ac Utilities
Public Safety
Date t,reatea ututb rtr.s
Fire Services
R.O.W.Permit Attachment of for
R.O.W. Permit# issued , 20 Atlantic Beach,FL 32233
Owner's Name: 7- rb/0,1 -C; (4i
Property Address: Ct.3 c u...silt( D Ak
Subdivision: fretp, 6 ro„.461, Glob R.E.#: 15-SFR-2355 / n-SFR-26130
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this 2 day of
Jo ( , 201 7, by Atlantic Beach, Florida, a municipal corporation or, anized and existing.
under tie laws of the State of Florida,hereinafter referred to as "CITY" and - iffaYpEic ,
of Atlantic Beach,Florida,hereinafter referred to as"USER".
WITNESSETH:
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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: Pk,,Le t J e ci-a¢
Y
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:
Sri Ca , 0 gk kA-00 , 4 h , � L . ?2233
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."
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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 anal-tlfat la 10 ,id liabilities are hereby assumed by the USER.
DATED : .d t NED + is 2G day of �/c14._/ , 20 /7.
Pro.: i caner
(to be signed in presence of the Notary)
STATE OF FLORIDA
COUNTY OF DUVAL
On this 1(011"' day of jt..,`\Y , 20 11 , personally appeared before me, a Notary
Public iend for said County and State, 1 N1 aG�ri > , the property owner of
6A3 C-00*Ak4�3rz33, Atlantic Be h, 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.
.AM .f— ,AtI_ I. -_.../►
No Public in f said County and State :r�'v GRACE h1ACKEY
?,: alp ?,;: MY COMMISSION#GG 042919
;. "N..o`e EXPIRES:Octcber 27.2020
; r«q°•' Bonded Thru NotaryPubf
K Urrderwntws
CITY OF ATLANTIC BEACH,FLORIDA,
a municipal corporation:
Approved:
k
Sco n%illiams
Interim Public Works Director
File: 12/12/16
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