825 SHERRY DR - REVISION 2/23/18 's'' '" '""E '11.' CITY OF ATLANTIC BEACH
800 Seminole Road
► r FEB 2 6 2018 Atlantic Beach,Florida 32233
REVISION REQUEST/CORRECTIONS TO PLAN REVIEW COMMENTS
Date h 3 1 4 Revision to Issued Permit l/ Corrections to Comments_ Permit# e-LS -00(4 3
Project Address ()- S S 1'Q_
Contractor/Contact Name Ma (2 ( C1
Phone Email
Description of Proposed Revision/Corrections: Permit Fee Due$
V b \ ikLk 2 -1(vC( -1 Ae01, *Di ItQA[
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
c
Department Review Required:
Building
Planning &Zoning Review•
Tr dministrator
ublic Works � ✓ 7 �}- C
Pu
Public Safety Date
Fire Services
* RIGHT-OF-WAY/ EASEMENT PERMIT
FEB 232018
`9B19' Permit#Issued by the City of Atlantic Beach Q Sil — 00_ 13 __ _j
PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES
Job Address gas-- S crr Or. Phone /C.)Li — 6-01— o i 3 L(
Permittee A14/1 ‘—ray Email G4ifoye., t ✓teff cty. (a✓ -
C
Requesting Permission to Construct I, a/,C- i.1�,IL_ 4 //IIa.
,f,..„E
Location(Reference to Cross-Street)
• 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 Aci,,v, G r /.A �n.rry 144 )i ry (Project Superintendent)
with Company Name T U(—r-�` c Phone�(1(- s
Ike / G•rip � �3-3
• All materials and equipment shall be subject`to inspection lfy 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. —S i,,x•.tp h Pre"...'/.. S'
• The permittee shall commence actual construction in good faith within 1 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
imme•. 0" upon completion.
_ Date 2/7 5
Per, ittee(signet in presence o •tary Public)
STATE OF FLORIDA,COUNT OF DUVAL C
The foregoing instrument was acknowledged this �� day of T L b(A.O(- ,20 i g ,
by kaii.fn C (ay ,who personally appeared before me and
(printed name of Permittee)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
_ Ii.lm
Per •,. , own (/
Signator • o . 'ublic 7' lorid., ,�• ed Id; tification(Type)
�� JENNIFER JO
'24:I'
�Y 0(9.C:
�� MY COMMISSION#GG 042984
'*, Heir l: EXPIRES:October 27,2020
�'' Pry Bonded Thnr Notary Public Underwriters
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