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705 Amberjack-fence CITY OF ATLANTIC BEACH ' 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 ";�;ii�,• INSPECTION PHONE LINE 247-5814 FENCE WALL OR BARRIER - FENCE MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: FNCE18-0006 Description: 6' FENCE Estimated Value: 0 Issue Date: 2/26/2018 Expiration Date: 8/25/2018 PROPERTY ADDRESS: Address: 705 AMBERJACK LN RE Number: 171193 0000 PROPERTY OWNER: Name: SALT AIR HOMES INC Address: 226 TALLWOOD RD JACKSONVILLE BEACH, FL 32250 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: AMERICAN CLASSIC HOMES LLC Address: 3481 St Augustine RD JACKSONVILLE, FL 32207 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. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. * 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. C../a,`.1:r6 City of Atlantic Beach APPLICATION NUMBER L. �� Building Department (To be assigned by the Building Department.) t 800 Seminole Road (�N Q E t OO� �� Atlantic Beach, Florida 32233-coab.u5445 1— (�j Phone (904)247-5826 • Fax(904)247-5845 J; y'�' E-mail: building-dept@coab.us Date routed: 1 e. I • City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 7 O_5 R(Y\- Q2 ..sf\Q Des - ment review required Yes No muildin. K Applicant: 0 c ,L) DJ nna i Zonin --Tree Administrator Project: r ,i0 Cl_ - blic Utilities Pubic ety--- 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: I "(Approved. I !Denied. ❑Not applicable (Circle one.) Comments: UILDINe PLANNING & ZONING Reviewed by: Date: ? - 2'a d r TREE ADMIN. Second Review: ['Approved as revised. ['Denied. Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 0 -AliN City of Atlantic Beach APPLICATION NUMBER ..3' friillgiNA, Building Department (To be assigned by the Building Department.) it 800 Seminole Road �� F)1 Atlantic Beach, Florida 32233-5445 F N C� 8 �� �:a r Phone (9 04) ing-de 247-5826• Fax(9us 247-5845 I qv ,Jj �? E-mail: building-dept@coab.us Date routed: iii. • City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: -7 a,5 RFY-Y ._sCK Department review required Yes No Building_) Applicant: �' DJ GR- 6 0 ( L� ,- nin• &Zonin• Tree Administrator Project: 0 is Or S..) blic Urirreb Pubic ety-- 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: Approved. ❑Denied. [Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by:1---- ---d/..- ---- Date: —( — 18- TREE ADMIN. Second Review: A roved as revised. ❑ pp ❑Denied. ❑Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 1.111..1 -el City of Atlantic Beach Pimmw-,.„.. APPLICATION NUMBE 8I Building Department "'” ,,,,,,..4.z.CVs,. (To be assigned by the Building DvN C 0. ;. . VA 800 Seminole Road FE 1 6, uL, I �� Atlantic Beach, Florida 32233-544 JAN j �O,p Phone(904)247-5826 • Fax(904 7-5845 w ;t19r E-mail: building-dept@coab.us BY Date routed: I a. I • City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: '710_5 P\fY\ 2..j fAcK, De artment review required Yes No uilding ) Applicant: 0 (-A--) P-D G---,R__ 6 (U t (_ ..( nnin &Zonin {�- 'Tree Administrator Project: �` .Ek) (\ blic Utilities Pubic ety--- 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: ❑Approved. WiDenied. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING (01,0'x'04' /-0r,J•� Reviewed bye / Date: / TREE ADMIN. Second Review: IVApproved as revised. Denied. 1� pp ❑ [Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed b • %%l _ , , `malate: /- i FIRE SERVICES Third Review: ❑Approved as revised. ❑Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 City of Atlantic Beach APPLICATION NUMBER Js #41triBuilding DepartmentflECEJ%JE (To be assigned by the Building Department.) r 800 Seminole Road j �� Atlantic Beach, Florida 32233 5445 JAN ' �— N C� 8 0006 Phone(904)247-5826 • Fax(904)247-58 2018 E-mail: building-dept@coab.us Date routed: I / et J 1 C� City web-site: http://www.coab.us BY:__. ttt APPLICATION REVIEW AND TRACKING FORM Property Address: / R t„,-\ �L-.J{-�C4„ Department review required Yes No � :uildin• Applicant: 0 � L � DJ 2 (� ( ` , nin• &Zonin': Tree Administrator Project: •.• is ""or Ad. blic Utilitie Pu• is - - 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: Approved. ❑Denied. ['Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed by: Date: LZ k TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. ['Not applicable PU',JOSS Comments: • BLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ❑Approved as revised. ['Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 F..W OFFICE COPBuilding Permit Application Updated 128 17 City of Atlantic Beach .io;i, . 800 Seminole Road,Atlantic Beach,FL 32233 Phone:(904)247-5826 Fax:(904)247-5845 r„,Job Address: 7o 5 A vv) (GF-712A ► 12 CI Permit Number: �I VCE I �'J �'D O D ' Legal Description t-OT g 6 i. woicy 4>.4L.Y11 s R. 1 /--7I I q 0000 Valuation of Work(Replacement Cost)$ .?0 • Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one) Addition Alteration Repair Move Demo Pool Window/Door • Use of existing/proposed structure(s)(Circle one): Commercial Residential • If an existing structure,is a fire sprinkler system installed?(Circle one): Yes No 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: Florida Product Approval# for multiple products use product approval form Property Owner Information Name: SAL ) A 1 ( O IM 5 I IJ C-- Address: Z--2 6 'A L,f-L JOO 4 Pid City 1 _ State_ .Zip 3 2c) Phone :33 E-Mail O 12. Cc-3YVl cA -; NEr j _ / Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company: Qualifying Agent: Address City State Zip Office Phone Job Site/Contact Number State Certification/Registration# E-Mail Architect Name&Phone# _ Engineer's Name&Phone# Workers 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 the laws regulationg construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING,SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS, and AIR CONDITIONERS,etc. NOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property that may be found in the public records of this county,and there may be additional permits required from other governmental entities such as water management districts,state agencies,or federal agencies. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance 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 FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECO. DING YOUR NO ICE OFOMMENCEMENT.) . ‘(.... AoLAA.3t, :0 OSZAT ,- Of'-‘"f\ A4 (Signature of Owner or Agent) (Signature of Contractor) (including contractor) y� Signed and sworn to(or affirmed)before me this t p' day of Signed and sworn to(or affirmed)before me this (, `day of �ci Cor 0S3l_lJ , by fl Vi L. V Z2ru0.7 , i,by (SCtV'et`s-°' GRACE MACKEY l • .X04: i . ,•, - MY COMMISSION#GG j" tr��'' �`��'� C(•,,, GRACEMACKEY a EXPIRES:October 27,2020 I Signature of Notary) 7 ;=o;r "4: n MY COMMISSION#GG 042 g a ureofNotary) '"*i�°P' Bonded Thru Notary Public Underwriters N; �m� i? i �Te.3e AV) Y AWY4 -V..: ..fAk•i EXPIRES:October 27,202 •j,F; ^'•an�p,d6tA�NS�tyPublic Underwriters [ 'Produced Identification n- . Lr ;" ,�.rpt—.ate, tlrtro, et Type of Identification: Ft_.DI V I S I -tit Type of Identification: rCi� S (�1 - a CITY OF ATLANTIC BEACH 'Vs' 13'WNER / BUILDER AFFIDAVIT . Blip, 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. 705 A'(Th(1ia�k La $0`1- Z-- 6607 ADDRESS PHONE NUMBER d LI ' KCL PRINT NAME acifii - Vjan 1— rg — 20 1� SIGNATURE DATE Before me this le day of , 20_18 in the county of Duval,State of Flonda,has personally appeare herin by himself/herself and affirms that all statements and declarations are true and accurate. !�' Notary Public at Large,State of ftor�cja.,County of DV al i :;: GRACE MACKEY 0 Personally Known r/ ((�� '�^y t :* .A. MY COMMISSION#GG 042989 [oduced Identification- r(� .tin V�T S Cl CQJ' ' ;a EXPIRES:October 27,2020 •'';o `,",•' Bonded Thru Notary Public Underwriters (,AL.VP..ef to Notary Signature: F.BLDG/Owner-Builder Affadavit;REVISED: 4/16/2009 /1J I\LIrV/\VL✓ rry r ✓.r ✓v v,. ..... ...r-... -,._ __. _. .. _ CERTIFIED TO: AMERICAN CLASSIC HOMES, LLC I� - .S.kC C J '' '') -7c >A Q L 0 T 2 2 BLOCK 5 1 LOT 2 3 {a BLOCK 5 6`✓•;oas .1✓�E= LOT 2 4 1D' DRAINAGE & W BLOCK 5 UTILITIES EASEMENT 0• 14.0 6' WOOD FENCE -S`8JC•20i02"E_ FND �" I.P. 125.00' NO I.D__ FND �" I.P. \?S77'39'49'E ---SET �" I • NO LD• 0.26' LB /3857 __ NO3'S 48 6'E c zz 144. 3.0' OFFSET 0.15' - -�u� 14.E - 0.1' 9",14" t= r. CEDAR Co N j CEDAR" 7 7",14"� •‘,.',, ,4.1 [ I o ro CEDAR Us) 4i o I 14.51 / ^47 4`. ' 21.3' k �T------- -4-8.; I L 0 T 8 / ��v�04 lo .. I ----- ----------L BLOCK 5 � i 48.7' (VACANT) / 14.5 I INTERIOR HOUSE, SHEDS I AND CONC. NOT LOCATED / b �1 h.5 in PROPOSED I O .I o 0I CUSTOMER I 14.8-.Ni// rn� rn • I o�i �t4.6 RESIDENCE I / #1762IF . Wx a 01 b W=48.67' I / I °0 D=60.50' I w I ¢ 14.9 /4. m to 14.3 F.F.E.=(15.50) to i f as I I M /" ►.,"�� M . '`14.7 / �' IPROPOSED / 40 0 �"--T4. ---1-iCOVERED -r-"/�/---� - +� 4' WOODX yy ; I 1 TRY o 3' i �% ti/OCA /� /17� /� FENCE FG/biJG'C I • I-.. r---1 1 �� O pV o (_ 21.3 18.9'_ I I 12.1'Lr5 1 �`-rt,(, / .���' 0 w , •B.L. L .• I I et„lb 'o- M `•PROPOSED a_---I 14.6 20.7, / R. �1� x__.. .• .D'IVEWgY x PROPOSED CONCRETE . �I' / �4, COMMUNITYDEVELOPMENT M N .•....•' •.. '... ENTRY WALK �� 1 1 0 \ �e8 V ¢ f 14. '� 4 ?c FNNO4I,D.P SET RAIL•..•:.•• M� 14. =ti (5 FND 4" I,P AND DISK NO I.D. ,` 24.7' LB #3857.•; •• N85'20'02"W 161.30' 2 wgrER . r s� (BEARING BASE) METERS Q 0 N85'20'02"W ; : : : : .. x ,3.71 29.54' _ X • , 73.8 C/ x�\ o o• 00 • CURVE DATA Cl _ , 13.7 N 73'18'42"W 22.o' OH- CH = 49.99' CONC. CURB & GUTTER R/SFE' -1'9Z6-'.'" 70. [ J 7 L (.._W •^ AMBERJACK LANE 12.87 9OA 4 pa000 _ R = 120.00' o�FR Approved By Permit Desk A = 50.36' (60' RIGHT OF WAY) Building Department = 24'02'40' 12.7 \ City of Atlantic Beach, FL rDepas CITY OF ATLANTIC BEACH ,, r yi rtment of Public Works s) 1200 Sandpiper Lane '' zy Atlantic Beach, FL 32233 \--:-/-01.119.1_)' /12 i (904) 247-5834 j / ..2 b 0 PUBLIC ORKS PLAN REVIEW COMMENTS Date: 1/24/18 Applicant: Salt Air Homes, Inc. Permit#: FNCE18-0006 ( D Fence) Address: 226 Tallwood Road Site Address: 705 Amberjack Jacksonville Beach, FL 32250 Atlantic Beach, FL 32233 Email: 0.Krau+ covncas-k-.hey PUBLIC WORKS CORRECTION ITEMS: (Submit the following to the Public Works Department in order for us to approve your application) • A Revocable Encroachment Permit must be obtained. PUBLIC WORKS CONDITIONS OF APPROVAL: (The following comments will be printed on your permit as Conditions of Approval) • 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., Republic Services, Donovan Dumpsters). Container cannot be placed on City right-of-way. • Full right-of-way restoration, including sod, is required. • All old fencing must be removed from job site by Contractor. Scott Williams, Director of Public Works swilliams(acoab.us /904-247-5834 Page 1 of 2 EG ON"E 0-.7 $y REVOCABLE ENCROACHMENT PERMIT pp' JAN 2 6 2018 ..r • i T l BY:._. THIS REVOCABLE ENCROACHMENT PERMIT, issued on this 2 day of J ic.ij ,20 l by the City of 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 for the purpose as described in the City of Atlantic Beach Right-of-Way Permit# . This work is generally described as WOO FE N C 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 "70 5 M ,. L- • • 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 assumed by the USER. 1� � Date 125- 7010 Property Owner/Agent(signed in presence of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL The foregoing instrument was acknowledged this a day of ��b erg t ,20 I t , by OG•-( V f�i E6 2-A V `1 ,who personally appeared before me and (printed name of Signer) acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. I A� Signat 4 of Notary Pu re, State lorida Approved/Public Works Department: Personally Known L„,---------- / Produced Identification T p e _ JENNIFER JOHNSTON .I /���� .1� ' '';;;'�a M,Y COMMISSION#GG 042984 Scott tl tams, Interim 'ubltc Wor s •irector i ,,,,, 4,,1,. tired r- EXPIRES:October 27,2020 "••,'F-;*"0'.'� Bonded Thru Notary Public Underwriters ri::.;\ ECEIVE "� RIGHT-OF-WAY/ EASEMENT PERMI _, JAN 2 62018 7411,1 )g))•• y Permit#Issued by the City of Atlantic Beach F tk --by)(: PERMITTEE RESPON,S�IBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES Job Address 705 A 2SAC( L� • Phone 0y - 333 - b 6a / Permittee SALT 41 R- HOM1 ) /NC_ , Email 0' KFAo c CDA( Ssi--7 Requesting Permission to Construct A .r iv E Location(Reference to Cross-Street) I b J�Cg- . 'E- JAN 2 5 2018 TI • 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 ©Lf v- IG'RA'JT (Project Superintendent) with Company Name LT Al r• LTO' f-c 1 NC Phone 9011- 833-6607 • 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 60 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 aforesaid rights and privileges. • The Director of Public Works shall be notified twenty-four(24)hours prior to starting work and again • ediately upon c pletion. J\ Date Permittee(signed in presence of Notary Pu lic) STATE OF FLORIDA,COUNTY OF DUVAL ,, � The foregoing instrument`twas acknowledged this Ok S day of PQM LACN ,20 1 g , by OL-IV v VR KRA ,who personally appeared before me and (printed name of Permittee) acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. 111V ` I41111111Personally Known Signatur4 otary Pu;i', a it : Ida dentification(Type) o, JENNIFER JOHNSTON �� MY COMMISSION#GG 042984 l'-si' id 14, w� EXPIRES:October 27,2020 •.Fo F gip' Bonded Thru Notary Public Underwriters