226 1st St 2006 Paver Driveway CITY OF ATLANTIC BEACH
CONSTRUCTION PERMIT WITHIN CITY RIGHTS OF WAY AND EASEMENTS
800 Seminole Road 904-247-5800
Atlantic Beach, Florida 32233-5445 Fax 904-247-5845
PLEASE SUBMIT(3) COMPLETE SETS OF RSrS WITH APPLICATION.
Dated ' ���/ PSUED BY THE CITYERMIT#
IS
Job Address �r� � �S� 1`
Permitee: 11tic.;.y" Telephone#
Permittee Address: L, ay.�1 JL S\t�v.c� I�fxli L+<y�ri/ loon-2 Qle.a. �1��• �4�� . 1.
z v4e ��:�. 3a1 4 Lo
Requesting Permission to Construct: �tu cay�+r �"F� _—_ �i
Location: (Reference to Cross-Street) c`�.1 t C��sT I•S t' S t`
1. Applicant declares that prior to filing this application he has ascertained the location of all existing utilities,
both aerial and !underground and the accurate locations are shown on the sketches.
A Letter of Notification was mailed to the following Utilities/Municipalities:
Jacksonville Electric Authority Yes ( ) No ( ) Date:
Bell South Telephone Company Yes ( ) No ( ) Date:
Ferrell GasYes ( ) No ( ) Date:
Comcast 151 Yes ( ) No ( ) Date:
2. Whe,iever necessary for the construction, repair, improvernent, 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 of 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.
3. All work shad meet City of Atlantic Beac 1�or Florida Depart ent of Transportation Standards and be
performed under the supervision of I1U .&CLL 4^r\ (Contractor's Project
Superintendent) located at ' % 1 idn Telephone#: W y - 7" 77i'y
4. All materials and equipment shall be subject to inspection by the Director of Public Works or his designee.
5. 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. lcalcu�adons sa^owina an i-ric.-wase M §AIMne'*jious area on a'ner's
Riaht of Wav are to be Inciuded yvith this ac-olicatio€1,
7. This permittee shall commence actual construction in good faith with _!3 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.
9. The Director of Public Works shall be notified twenty-four (24) hours prior to starting work and again
immediately up completion.
OWNER
DONNA L BUSSEY
Signed: dYl/YLGt Date: DG * MY COMMISSION#DD 412624
Before me this day of AeIM r in t County of Duvp1, "C. EXPIRES:March 30,2009
State Of Florida, haspersonallyappeared Qn►e 4 ea3/ /Y)a CN"N ,„; 9ondedTtnuNot"PiAAcundewiters
Notary Public at Large,State of Florida,County of Duval- /
My commssion expires: 4A do,_a OL 9 Personally Known:
>y �LGDf,�ve.r License Produced Identification:
R.O.W.Permit Attachment of for
R.O.W.Permit# issued 92005 Atlantic Beach, FL 32233
Owner's Name: ►�► /�C ✓a
Property Address:
ok k n 11 C
Subdivision:
Lot#/Block#:
R.E. #:
REVOCABLE ENCROACHMENT PERMIT
THIS REVOCABLE ENCROACHMENT PERMIT, issued on this day of
2005, by 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 of the City of Atlantic Beach for the purpose as described in the City of
Atlantic Beach Right-of-Way/Easement permit numbers noted above(copies attached).
This work is generally described as:
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 the USER, said notice to
USER shall be given by certified mail, return receipt requested, to the following address:
a(e 5, S� X4 ��an T7 G �a
The depositing of said notice of cancellation in the United States mail shall constitute the notice of
cancellation and the burden is upon USER to keep the CITY informed of USER's proper address.
The USER shall promptly make any and all necessary repairs to any facility erected or maintained in
the exercise of the privilege herein granted and shall at all times maintain said facility in good and safe
condition.
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.
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. The
Page 1 of 2
USER shall, at the discretion of the CITY, be requested to submit as-built drawings showing the change
within thirty (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 rights-of-way 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.
DATED and SIGNED this�day of , 20
CITY OF ATLANTIC BEACH,FLORIDA, By:
a municipal corporation: Property Owner
By:
Jim H on, City Manager
Attest:
Ric er,Pu is Works Director
STATE OF FLORIDA
COUNTY OF DUVAL �, ""
On this 1 Sf day of bee , 20 , personally appeared before me, a Notary
Public in and for said County and State, Amela Rs/ f/Y1�vw , the property owner of
Atlantic Beach, Florida, knov to me to be the person(s)
described in and who executed the foregoing instrument; who acknowledged to me that he or she
executed the same freely and voluntarily and for the uses and purposes therein mentioned.
�l'1/r1lZ By:
Notary Public in for said Coun nd State Property Owner
((to be signed in pres nce of the No )
DONNA L BUSSEY
MY COMMISSION M DD 412624
EXPIRES:blanch 30,2009
9awwd TMU Nowy f ok uncmvAteis
Page 2 of 2
r !!j
} 1 a�+ �+ � E Mme'^^+ � • �`
i `'a • �E"F.1�wiw� i��� l iVid�r iW� i
a a
4
.....
LI
LI
-1,00 - law
1
4 31
carie CA1 +�+
L k ra Uot iu 6e AAS# Al ba4
i
f I
r
{
i
e-s Ae—t L '
Day-,
\\ i'
A&
n . 61aha t A trot#-"A E'f
C1 - 20*7 -sib
7 s cs ` mil