610 Begonia St RES19-0016 Revocable Encroachment Revision Request/Correction to Comments **ALL INFORMATION
�rSS �i`' HIGHLIGHTED IN
/" City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 ,e. i I 1 - ow
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: --
1 i
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1 Revision to Issued Permit OR I�p Corrections to Comments Date: HP/
Project Address: COW O V FV 0-vA S 'r
Contractor/Contact Name: r'3^ t /moi v.2.\>h eo r-5r4--(=4,/
Contact Phone: 10t4 1:7 – U CZ 17 Email: 51104 zc CoS C-' 9/`4 / (-" -"
Description of Proposed Revision/Corrections:
PI.cLIZ5 i C��-y 0 R-i4n�ti1. 8t--4-4 (2.`5 J -
? s Pe--a l,f1-1-,-,714..( C 4 55.E;s- 4.;.---14`...,s. .
1 4P kr I''`'- (',-- affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• Will proposed revision/corrections add additional square footage to original submittal?
.4-No ❑ Yes (additional s.f.to be added: )
• Will roposed revision/corrections add additional increase in building value to original submittal?
o ❑*Yes (additional increase in building value: ) (Contractor must sign if increase in valuation)
*Signature of Contractor/Agent: . —
(Office Use Only)
L✓J Approved [I Denied _I Not Applicable to Department Permit Fee Due
pp pp p $
Revision/Plan Review Comments
r
Department Review Required:
Building Sy
Planning&Zoning 'w Reviewed By
Tree Administrator / ; iv '
Public waw NOV 0 209 7ii��
Public Utilities
Public Safety I A Date
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Fire Services : :----____.______ Updated10/17/18
REVOCABLE ENCROACHMENT AGREEMENT
City of Atlantic Beach **ALL INFORMATION
4� r 800 Seminole Road,Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY
\ J IS REQUIRED.
REVOCABLE ENCROACHMENT AGREEMENT 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
HOLSTAR, LLC 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 Pavers installed in the Righ of Way
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 610 Begionia Street Atlantic Beach Fl 32233
• 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 hereb sumed by the USER.
Date /✓O v /, 2
Property Owner/Agent(signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL ,,
The foregoing instrument was acknowledged this CA-- dayday of /�0 u , 201 9
by a--cQD %-( . � � ,who personally appeared before me and
(printed name of Signer)
acknowledged that he/she signed the instrument voluntarily for the purpose expressed in it.
�.01111110" �I '•; JUNE CODNER-KONGQUEE
�� 6" Commission#GG 279787 Department Ap royal:
.,.� Z Expires February 8,2023
Signature of N N.OM blic, State of Florida lo; o.• gondex n,,,,TroyFau, BOO.385.7019 f
[ ] Personally Known / ` tW l ?%72 0 4.—
[Produced Identification(Type) —c�� S S(� l�3( 4 Scott i liams, Public I"orks/Director
H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18 /���"