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592 ROYAL PALMS DR - FENCE CITY OF ATLANTIC BEACH ,` :i 800 SEMINOLE ROAD . i �� ATLANTIC BEACH, FL 32233 "�Olt �'' INSPECTION PHONE LINE 247-5814 FENCE WALL OR BARRIER - FENCE MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: FNCE18-0008 Description: 6'WOOD FENCE Estimated Value: 0 Issue Date: 3/7/2018 Expiration Date: 9/3/2018 PROPERTY ADDRESS: Address: 592 ROYAL PALMS DR RE Number: 171519 0000 PROPERTY OWNER: Name: CARTLIDGE ELIZABETH R Address: 592 ROYAL PALMS DR ATLANTIC BEACH, FL 32233 GENERAL CONTRACTOR INFORMATION: Name: Address: , Phone: Name: Address: , 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. City of Atlantic Beach APPLICATION NUMBER JS • _ Building Department (To be assigned by the Building Department.) \` 800 Seminole Road I Atlantic Beach, Florida 32233-5445 FN c� l/ 8 y0c0 Phone (904)247-5826 • Fax(904)247-5845 E-mail: building-dept@coab.us Date routed: d / Z� http://www.coab.us web site.: APPLICATION REVIEW AND TRACKING FORM Property Address: 59 Z (-( Pfl-LimS Department review required Y-es/No uildm Applicant: 0(,DKJ E--Z _ manning &Zoning Tree Ad n strator - Project: FEfoublic or s� Public Utilitie ublic Safety 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: pproved. (Denied. ❑Not applicable (Circle one.) Comments: eo n ort s de" I ec IUILDIN PLANNING & ZONING ^ 2' 2''Ul Reviewed by: K Date: 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 ,;i!Avr�J City of Atlantic Beach APPLICATION NUMBER J1A Building Department (To be assigned by the Building Department.) r800 Seminole Road Q /��y�Q co8 1 Atlantic Beach, Florida 32233-5445 FN 8 1 —O Phone(904)247-5826 • Fax(904)247-5845 T� E-mail: building-dept@coab.us Date routed: 1, / City web-site: http://www.coab.us yy APPLICATION REVIEW AND TRACKING FORM Property Address: S9 Z Ro - A L. PLJS Department review required Yes No uildin Applicant: 0(ADp)(--=(z _ fanning &Zoning Tree Administrator Project: FE •D public Work' 'ublic Utilitie —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 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: rr eed5� Z4c Lc is s ,'c(e w«I k BUILDING PLANNING &ZONING Reviewed by: Date: /-Z� 1 fl 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 .S„1P1 CITY OF ATLANTIC BEACH z� 800 Seminole Road 75 �� Atlantic Beach,Florida 32233 `��.91-69',- REVISION REQUEST/CORRECTIONS TO PLAN REVIEW COMMENTS Date 2, ) ( 4 I1(1 Revision to Issued Permit Corrections to CommentsC -- Permit# FN .,I $ Ooo� Project Address S 92 061,1 r_ .. l PPI--)SMS 1 )r--- Contractor/Contact Name nen TZ c-k ,gkiA /L. Phone `f j - , f�D Email r/ �k 0p D©. C o� Description of Proposed Revision/Corrections: Permit Fee Due $ (S - L4) s is 1e Jc l - A A cb r6ccct5 e---11 icks. Additional Increase in Building Value $ Additional S.F. By signing below,I Get C- l A [ 1'L affirm the Revision is inclusive of the proposed changes. (printed na e) /'' i ,P--/61 //V Signature of Contractor/A ent Contraif increase in valuation) Date t� g � sign (Office Use Only) Approved / Denied Not Applicable to Department Revision/Plan Review Comments Department Review Required: Building annin & Zoning Reviewed By Tree Adminis ra Public Works --�-C1— I e Public Utilities Public Safety Date Fire Services Livi,yr, City of Atlantic Beach APPLICATION NUMBER :YA Building Department (To be assigned by the Building Department.) 800 Seminole Road ...Cl��VE FM l O w�V �ti, �r Atlantic Beach, Florida 32233-5445 IJ��CJV Phone (904)247-5826 • Fax(904)2 589�N z 5z� / �7 /I 0;1 �. E-mail: building-dept@coab.us Date routed: t d Lit t g City web site: http://www.coab.us tY:_. APPLICATION REVIEW AND TRACKING FORM Property Address: 59 Z. 1RO(-fpi L PAUYI-S Department review required Yes No uildin Applicant: 0,,p.,)c=fzfanning &Zoning Tree Administrator Project: FEAJ ublic Wo s--- (%-"—Public Utilitie Public Safety Fire Services Review fee $ Dept Signature k- 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 &ZONING1 Gam_ I� Reviewed by: kteli ' Date: TREE ADMIN. Second Review: ['Approved as revised. ❑Denied. ❑Not applicable PU:4fWORKS Comments: . : C ILITIES 1-7 60?— / r PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: ['Approved as revised. ['Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 :o-up, City of Atlantic Beach APPLICATION NUMBER S r .. Building Department �� (To be assigned by the Building Department.) �- 800 Seminole Road �(v I y/�� Atlantic Beach, Florida 32233-5 JAN 2 5 20�$ h V Phone(904)247-5826 • Fax(9 247-5845 8 r�;;i9r E-mail: building-dept@coab.us gy:_ ._ Date routed: _ City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 59 Z Rol V A L. 1-'PI-Lms.s Department review required Yes No _` uildinq T Applicant: L (ADK) E::2 Winning & Zirg iTree Administrator Project: FEPJC .----1:5-ublic WorRs-, Public Utilit es) ublic Safety 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. 1enied. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING Reviewed b . ,J//%/__ r A//.i Date: lra 7, TREE ADMIN. Second Review: Approved as revised. nDenied. ['Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES .k-- • - PUBLIC SAFETY Reviewed b : //d , I- -: ,j y e �, FIRE SERVICES Third Review: Approved as revised. nDenied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 CITY OF ATLANTIC BEACH 800 Seminole Road MAR 01 2018 Atlantic Beach,Florida 32233 REVISION REQUEST / CORRECTIONS TO PLAN REVIEW COMMENTS Date I d-g Revision to Issued Permit Corrections to Commentsi/Permit# F t (i I -bC q Project Address S c1 (LO s ct Pal VYA br Contractor/Contact Name C) \-3 , Q_ Phone CIO't -a1G1 'Si `iL Email (k kGr P\dr1dA (oK4S IC- -0001 Description of Proposed Revision/Corrections: Permit Fee Due $ f O-V cc& e,n uoct uv -n :Y ,. par-tt-�- 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 Planning & Zoning eviewed y Tree Adminiacator C Public Warks___) Public Utilities Q27, Public Safety Fire Services CITY OF ATLANTIC BEACH :.) 'ssiDepartmentofPublicWorks(1 1200 Sandpiper Lane : • •J Atlantic Beach, FL 32233 J,31 `' (904) 247-5834 PUBLIC WORKS PLAN REVIEW COMMENTS Date: 1/26/18 Applicant: Rick Baker Permit#: FNCE18-0008 (DENIED Fence) Address: 592 Royal Palms Drive Site Address: 592 Royal Palms Drive Atlantic Beach, FL 32233 Atlantic Beach, FL 32233 Email: rbaker@floridaroadsllc.com APPROVED PUBLIC WORKS CORRECTION ITEMS: 5 --iZ 7r (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@coab.us /904-247-5834 Page 1 of 2 THIS PLAN REVIEW IS ONE OF MULTIPLE DEPARTMENT REVIEWS Any plan change must be submitted as a Revision to the Building Department at 800 Seminole Road. Revisions may not be submitted until ALL departments have completed their respective reviews. Revisions submitted MUST respond to EACH department review. Submittals that respond to only one or a few correction items will not be accepted. Resubmittal Notes: All revisions and changes shall clearly stand out from the rest of the drawing on the sheet as a revision by way of completely encircling the change with "clouding".The revision shall also be identified as to the sequence of revision by indicating a triangle with the revision sequence number within it and located adjacent to the cloud.The revision date and revision sequence number shall also be indicated in a conspicuous location in the title block for each sheet on which a revision for that sequence occurs. For projects still in the initial review stage and permit pending, all sheets with revisions shall be inserted into each set of drawings.The original sheets must be clearly marked "VOID" but are to be left within the set of drawings. Complete new sets of drawings will not be accepted.ADDITIONAL ITEMS MAY BE REQUIRED DEPENDING UPON NEW INFORMATION AND CLARITY OF FINAL PLANS SUBMITTED FOR REVIEW. Page 2 of 2 }y !!F�1➢ teBuilding Permit Application Updated 12/8/17 -A.-10 City of Atlantic Beach 800 Seminole Road,Atlantic Beach,FL 32233 CE r /f /� Phone:(904)247-5826 Fax:(904)247-5845 FN Is -0008 Lv 0 08 Job Address: Z 'NI a / P4/My Dr. Permit Number: Legal Description RE# Valuation of Work(Replacement Cost)$ 2A-4.a c0 - Heated/Cooled SF Non-Heated/Cooled • Class of Work(Circle one): ew 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 (lLA ,} • 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: • Go00d. � ! Florida Product Approval# for multiple products use product approval form Property Owner Information Name: / e-c.k. 4-k:e'L Address: S7 2-- /2c' A J ici1ili,t4.( City got j3 r/ State F r` Zip 3 2 2 3 3 Phone 5 v y -- 2-/ `f - gi p F4' E-Mail Imo'/ ker � f7r "IAe'e- c1 A% [(C . CD Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company: Qu Ing Agent: Address Ity State Zip Office Phone J ite/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 RECORDING YOUR NOTICE OF COMMENCEMENT. (Signature aYwOner or Agent) (Signature of Contractor) (includi :contractor) Si ed and sworn to(or affir es)before e t 2 day of Signed . d sworn to(or affirmed)befpre me this day of a,� , Znl rJby 'IMAM' � . CP by f� _ ••• •-+ � (Signature of Notary) '"� of TONI GINDLESPERGE' P`c' MY COMMISSION#FF 924. �` �4 '` [ ] Personally Known OR [ ]Personally Known 0•:iti , `:a EXPIRES:October 8,2(119 [ ]Produced Identificat ;We.P''' ' Bonded ThruNotary Pub*Linde naiters [ ]Produced Identification Type of Identification: _ Type of Identification: .I yAP1y e CITY OF ATLANTIC BEACH '' ' WNER / BUILDER AFFIDAVIT -r);119r• 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. ADDRESS /t vi'14) Pat J or �� �^ Old PHONE NUMBER PRINT NAME XJ-11716) SIGNAT DATE Before me thisG=��,///day of�C(1 ,20 lathe county of Duval,State of Florida,has personally appeared herin by himself/herself and affirms that all statements and declarations are true and accurate. Notary Public at Large,State of F( ,County of__yS �( 2AEQ. ❑Personally Known ' ,� 4 `r --• *<+•Y�r'r TONT GINDLESPERGER ❑Produced Identification- ,.� ;;: MY COMMISSION II FF 924951 4.= EXPIRES:October 6,2019 ' o $ Bonded Thru Notary Public Underwriters Notary Signature: • -•-•....„‘ , F:BLDG/Owner-Builder Affadavit;REVISED: 4/16/2009 , • , ,c?\ "'Y - REVOCABLE ENCROACHMENT AGREEMENT 04-4 . 9f REVOCABLE ENCROACHMENT AGREEMENT by the City of Atlantic Beach,Florida,a municipal corporation organized and,,gxisti g under laws f the State of Florida,hereinafter referred to as"CITY"and ��//�`'/', G i1 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 F,c,yam Any facility maintained, repaired, erected, and/or installed in the t4tercise of the privilege granted remains subject to relocation or removal on thirty(30) days' notice by CITY to USER, sa notice to USER shall be given b certified/mail, mail return receipt requested,to the following address Z_ �j ,4-/ PAhc_ ,' / ilia 4 i�ITC4CG • 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 easement or 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 easements, 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 assu/42,,,02., ed by the USER. Date Z/2 rC f Property Owner/Agent(s ned in presence of Notary Public) STATE OF FLORIDA,COUNTY OF DUVAL The foregoing instrument was acknowledged this a1. day of re, )1 .&IN `k ,20 I U , by OA i'- U tfJGhte. 1i ,who personally appeared before me and (printed name of Signer) acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. iMY° o � , JENNIFER JOHNSTON r, u. '¢: MY COMMISSION#GG 042984 N IUI µ' ").___. .,.,,,,,,,..G.,.„.0..,.., EXPIRES:October 27, Bonded Thru NotaryPublic Underw2020riters Sign e o lio ary Public, State of Florida Department Approval: Personally Known Produced Identification(Type) FL 6—IA)9-11 S l tce n& Scott Wi hams,Pup is Wor s Direc or/ Kayle Moore,Public Utilities Director H:\Master Forms\Public-Utilities Works Forms\Revocable Encroachment Agreement 2.5.18.docx Revision Date:2/5/18 r RIGHT-OF-WAY/EASEMENT PERMIT F E B 2 8 2018 �,;:„s- y Permit#Issued by the City of Atlantic Beach PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES Job Address S 5 /9ci,4 j 1 /tis J( Phone %Q 17'' 21 9.— S7,U PermitteePickEmail (-,6a ee-(iOrtcAckt” ots 11' Ce)0 Requesting Permission to Construct F,Cj'`t/C£ Location(Reference to Cross-Street) 129 A-I P6-111-1-5 a/1 P/+44 • 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 t) wit/er (Project Superintendent) with Company Name 0U/4,_� Phone 9a/" 2_19 - SIS.yv • 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 aforesaid rights and privileges. • The Director of Public Works shall be notified twenty-four(24)hours prior to starting work and again immediately upon corn let' n. /I / Date Z`2e// P Permittee(sign r pesent otary Public) STATE OF FLORIDA,COUNTY OF DUVAL ,,‘ Q �-e The foregoing instrument was acknowledged this ` 0 day of f c-b 1 tkc•N ,20 1 g , by U LA l LA t kcid\O1A fsalk-( d1r • ,who personally appeared before me and (printed name of Permittee) acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it. \ • IAM mi.. Known Signa ite o'1:4 ! 'ub. ate of Flo ;' -13-^-1.—^ Identification(Type) FL 3--(.11)q.r`Sl:CO i'1LQ 0;1, ;u,;,•.,^ JENNIFER JOHNSTON '* MY COMMISSION#GG 042984 *• Ilm° : : EXPIRES:October 27.2020 �`Z,Z) Bonded Thru Notary Public Underwriters L__ � _ ° � ` H