2309 FIDDLERS LN - REVISION 12/20/17 ,� ,,.../!J-vi rje.,
CITY OF ATLANTIC BEACH
'- DEC2 j 2017 800 Seminole Road
Atlantic Beach,Florida 32233
REVISION REQUEST/CORRECTIONS TO PLAN REVIEW COMMENTS
Date (c IO I rt Revision to Issued Permit / Corrections to Comments Permit# 113Wit`{ VF - 00(IS
Project Address 3 r-` d At(S t
Contractor/Contact Name 0 L /\Q-(
Phone Email
Description of Proposed Revision/Corrections:` Permit Fee Due $
( l3 h \ d T w Gt y pr4 rfNZ-}-
Additional Increase in Building Value $ Additional S.F.
By signing below,I affirm the Revision is inclusive of the proposed changes.
(printed name)
Signature of Contractor/Agent(Contractor must sign if increase in valuation) Date
(Office Use Only)
Approved Denied Not Applicable to Department
Revision/Plan Review Comments
Department Review Required:
Building 514)
Planning & Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities 12-21-11
Public Safety Date
Fire Services
:: - s REVOCABLE ENCROACHMENT PERMIT
DEC 222017
W p - L 7- 0 C)03
REVOCABLE ENCROACHMENT PERMIT hyo*h.., .»P a Atlantic Beach,Florida,a municipal corporation
org9ized and existing under the laws of the State of Florida,hereinafter referred to as"CITY"and
itb. ttST 2 Pt 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 for the purpose as described in the City of Atlantic Beach.
This work is generally described as 1)402,12s .
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 USER, said notice to USER shall be given by certified mail,
return receipt requested,to the following address /3O1 PiDh&. '2s LAgfn_. .
• 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."
• 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 within 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 right-of-ways 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
sum/ by the USER.
/41,,
, /sem Date /A/2/4Z—
Proper
/ /Z
Proper (Owner/Agent(signe s i : -sence of Notary Public)
STATE OF FLORIDA,COUNTY OF DUVAL
The foregoing instrument was acknowledged this �.% day of .b Tr ,20 1'4- ,
by Jenkt.) t STEP-xtE,,h. ,who personally appeared before me and
(printed name of Signer)
12 ackn ledged that he/she signed the instrument voluntarily for the purpose expressed in it.
Qv- 4111
2re of Not '- 'lie, State of Fe ida
Approved/Public Works Department:
Personally Known
Produ -' a-• • - --....---• -;"_---'
gYit,":%
TO 1 I��L MYCOMMISSION#FF 924951
i_
EXPIRES:October us 2019 Scott Williams,Public Works Director
4..1i b?' Bonded ThN Noary Public Underxrters
T Enik- uvb_, n-
. 1 . i
. gT . AY / EASEMENT PERMIT
;' 1 DEC217il
j
<< Permit#Issued b City of Atlantic Beach be y I7.- S
PERMITTEE RESPONSIBLE FOR FYING 811 AND OBTAINING UTILITY LOCATES
Job Address 2301 cibbill2s 1,44q1... Phone q 04.1qc, .74W
Permittee ,1, , 0s_sWg2 R l4 IA, Email i',N.__siEj2p.1 plea:WA yf S r'
Requesting Permission to Construc _ ;,," ;..111 . 'Nags
y
Location(Reference to Cross-Street)
r.,4 F.., QS 44Ntl-
• Permittee declares that prior to filing this application they have ascertained the location of all existing utilities,
both aerial and underground and the accurate locations are shown on the sketches.
• Whenever necessary for the construction,repair,improvement,maintenance,safe and efficient operation,
alteration or relocation of all,or any portion of said street or easement as determined by the Director of Public
Works,any or all said poles,wires,pipes,cables or other facilities and appurtenances authorized hereunder,shall
be immediately removed from said street or easement or reset or relocated hereon as required by the Director of
Public Works and at the expense of the Permittee unless reimbursement is authorized.
• All work shall meet City of Atlantic Beach or Florida Department of Transportation Standards and be performed
under the supervision of ... .215t. ._ , & o—.— (Project Superintendent)
with Company Name IN h+2_ 6MbPhone Qo4, 4r3. b 7L5
• All materials and equipment shall be subject to inspection by the Director of Public Works.
• All city property shall be restored to its original condition as far as practical,in keeping with City specifications
and the manner satisfactory to the City.
• A sketch of plans covering details of this installation,as well as a copy of a recent survey shall be made a part
of this permit. Calculations showing any increase in impervious area on owner's lot or in the City
right-of-way are to be included with this application.
• The permittee shall commence actual construction in good faith within days. If the beginning date is more
than 60 days from date of permit approval then permittee must review the permit with the Director of Public
Works to make sure no changes have occurred in the area that would affect the permitted construction.
• It is understood and agreed that the rights and privileges herein set out are granted only to the extent of the City's
right,title and interest in the land to be entered upon and used by the holder,and the holder will,at all times,
assume all risk of and indemnify,defend and save harmless the City of Atlantic Beach from and against any and
all loss,damage and cost of expenses arising in any manner of the exercise or attempted exercises by the holder of
the . -.resaid rights and privileges.
• T Director of Public Works shall be notified twenty-four(24)hours prior to starting work and again
mediately upon completion. /
/ `"7
:;,,, Date 1 l
Per- ittee(sign-d in presence • otary Public)
STATE OF FLORIDA,COUNTY OF DUVAL hi
'
The foregoing instrument was acknowledged this a0 day of 0 g_e_m € ,20 11 ,
by q'Dr`n I) , cQil•Sit_( C, Lick ,who personally appeared before me and
(printed name of Permittee)
acknowledged that he/she igned the instrument voluntarily for the purpose expressed in it.
AA .1 A. , h.:__ Personally Known r
Signator f Notary�1•li° ate of Flon a Produced Identification(Type) U•S. 1d.n.c1 M 2 d
S12r4,LkSIn