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825 Sherry Dr RES19-0056 ROW Application , err RIGHT-OF-WAY/ EASEMENT PERMIT APPLICATION **ALL INFORMATION a 1,_y1� City of Atlantic Beach HIGHLIGHTED IN GRAY IS k * 800 Seminole Road,Atlantic Beach, FL 32233 REQUIRED. vQ PERMITTEE RESPONSIBLE FOR NOTIFYING 811 AND OBTAINING UTILITY LOCATES Job Address Ste. Permit Number tc2Z S /9-4052, cy Contractor Information Company ; 50,,, ]C/� ,cayo(7.4:L/ • L L• Qualifying Agent '4,4.4.4 n��/ Addressy._`-S s 3'2-e City W,x.(1elam.- .,..<.?--. State 7 / Zip _.c:::2Z,"'-:7 Phone fC,/7_9X1._E)S—;2- Email _ , 7 >A!.J' I' > • .i , ` 'e2 i State Certification/Registration# �8e 4-5�G�cG. Architect Phone Email Engineer Phone Email Workers Compensation Insurer OR Exempt I( Expiration Date /0 -7"' .pb-10 • 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 Public Works Director,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 Public Works Director 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'S2 , - _ (Project Superintendent) with(Company Name) J`jcz,ep�Q. ��J6^-tir /;Al Phone 9©4/-9,..r—OSP7 • All materials and equipment shall besubjectto inspection by the Public Works Director. • 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 /O days. If the beginning date is more than 60 days from date of permit approval then permittee must review the permit with the Public Works Director 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 f the exercise or attempted exercises by the holder of the aforesaid rights and privileges. • The Works Direc all be notified hours prior to starting work and again immediately upon completion. X -�" ,l Dat �3-8OOO Permittee( ned in prese e of Nota ubT lic) STATE OF FLORIDA,COUNTY OF DUVAL The foregoing instrument was acknowledged this day of Feb ,20 Z.0 , by (5-6-1740A...9 A0 upn 7•P ,who personally appeared before me and (printed na/meof Permittee) ' ''.o,''•.. TONI GINDLESPERGER ack o edged tha she igned the' strument voluntarily for the purpose expressed in ? MY COMMISSION#GG 353178 •.4'.ems,•n; EXPIRES:October 6,2023 ' REO °c: Bonded Thru Notary Public Underwriters \ Personally Signature of Notary Public,State of Flori.. [ ] Produced Identification(Type) H:\Applications&Forms\Word&Excel Document Originals\201801001 Right-of-Way Easement Permit Application.docx Revision Date:10/1/18