423 Irex Rd FNCE20-0123 Permit PacketOWNER:ADDRESS:CITY:STATE:ZIP:
SUTER AMANDA & BARAK
DAVIS 423 IREX RD ATLANTIC BEACH FL 32233-3904
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171414 0000 ROYAL PALMS UNIT
02A3.00
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
423 IREX RD FENCE WALL OR BARRIER FENCE FENCE $2000.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
1 PUBLIC WORKS ON SITE RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site during construction.
2 PUBLIC WORKS ROLL OFF CONTAINER INFORMATIONAL
Notes:
Roll off container company must be on City approved list. Approved list can be obtained at the Building Department at City Hall. Roll off container
cannot be placed on City right-of-way.
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.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN
YOUR 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.
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
1 of 2Issued Date: 11/18/2020
PERMIT NUMBER
FNCE20-0123
ISSUED: 11/18/2020
EXPIRES: 5/17/2021
FENCE WALL OR BARRIER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
BUILDING PLAN CHECK 455-0000-322-1001 0 $17.50
FENCE 455-0000-322-1000 0 $35.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $81.50
3 PUBLIC WORKS RIGHT OF WAY RESTORATION INFORMATIONAL
Notes:
Full right-of-way restoration, including sod, is required.
4 PUBLIC WORKS RUNOFF INFORMATIONAL
Notes:
All runoff must remain on-site. Cannot raise lot elevation.
5 PUBLIC WORKS FENCING REMOVED INFORMATIONAL
Notes:
All old fencing and debris must be removed from job site by Contractor.
6 PUBLIC WORKS INFRASTRUCTURE INFORMATIONAL
Notes:
Any damage done to infrastructure must be repaired by Contractor.
7 PUBLIC UTILITIES UNDERGROUND WATER SEWER UTILITIES INFORMATIONAL
Notes:
Avoid damage to underground water and sewer utilities. Verify vertical and horizontal location of utilities. Hand dig if necessary. If field coordination is
needed, call 247-5878.
2 of 2Issued Date: 11/18/2020
PERMIT NUMBER
FNCE20-0123
ISSUED: 11/18/2020
EXPIRES: 5/17/2021
FENCE WALL OR BARRIER PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $81.50
FNCE20-0123 Address: 423 IREX RD APN: 171414 0000 $81.50
BUILDING $35.00
FENCE 455-0000-322-1000 0 $35.00
BUILDING PLAN REVIEW $17.50
BUILDING PLAN CHECK 455-0000-322-1001 0 $17.50
PUBLIC WORKS PLAN REVIEW $25.00
PW REVIEW BUILDING MOD OR ROW 001-0000-329-1004 0 $25.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R14143 $81.50
Printed: Wednesday, November 18, 2020 3:11 PM
Date Paid: Wednesday, November 18, 2020
Paid By: SUTER AMANDA & BARAK DAVIS
Pay Method: CREDIT CARD 396261471
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R14143
~+; CENTRALSQUARE
FNCE20-0123
Owner Builder Affid avit
City of Atlantic Beach Building Department
800 Sem i nole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email:
**ALL INFORMATION
HIGH LIG HTED IN
GRAY IS REQU IRED.
PERMIT#: ______ _
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 EX EMPTION 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 VEAR 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
RE UIRED 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 .,
Ill. 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 THE I R IMPROVEMENT T RADES.
IV. PENALTY; UNLICENSED CONTRACTORS CANNOT BE EMPLOYED UNDER ANY CIRCUMSTANCES. OWNERS BEING SUBJECT
TO $5,000 PENALTY UNDER FLOR IDA STATU TE NO. 455-228(1). AN "OCCUPAT IONAL LICENSE" IS NOT ADEQUATE. THE
OWNER SHOULD PHYSICALLY SEE THE COUNTY "CERTIFICATE OF COMPET ENCY" OR THE FLORIDA "CONTRACTORS
CERTIFICATE" TO ASCERTAIN IF A PERSON IS A LICENSED CONTRACTOR. CONTACT THE BUILDING DEPARTMENT (904-
247-5826 OR _ ) I F IN DOUBT.
V. ACKNOWLl:DGEM£NT; 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.
Job Address: 423 lrex Road Atlatnic Beach FL 32233
Owner Name: Barak Davis Phone Number: _,_(9_0_:,4)_7_55_-4_1_2_9 ____ _
Mailing Address: _42_3_1_re_x _R_oa_d ________ City: Atlantic Beach State: FL Zip: 32233 ----
Notarized Signature of Owner ~~
The foregoing instrument was acknowledged before me this.2"'J day of /1.Jo>r-e,n,,.lo,;r 20 ~ in the State of Florida. County
of n 1.A-" C\. I
,.-fi'~~~~i'> CHRISTY RIGNEY
[,/' d1 \\ Comrnission#G G 190226
·-~.t~l: Expires May 31, 2022
•,~~h~ .. •' 9ond~d Thru T1oy ;ain lnsuranta 800.385 .7019
Signature of Notary Public --~-----~__._..__A __ ~-=--·_;_ _______ _
[ ] Personally Known OR [ "(Produced Identification
Type of Identification: FL oL f"J-0 -06 ,_ 8"5'-Usl~o E¥ 5-;J7-'J.O;J7
Updated 10/24/18
FNCE20-0123
Building Permit Application
) City of Atlantic Beach Building Department
800 Seminole Road, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email:
Updated 10/9/18
**ALL INFORMATION
HIGHLIGHTED I N GRAY
IS REQUIRED.
Job Address: 3 #) ,ATl.,tA)T,Z(_ ~ Yc2 :£/?EX l'<.0;4-D 3o?..23:S PermitNumber: ________ _
Legal Description I 3 I -/ '-r 17 -d .s -Qq e I<# a:F ff 6 -F
/l...o"fA-L. PA-L A5 Vll,./<r:~A ~0~~3.gt:_J,c ... /.O ~A Valuation of Work (Rep lacement Lost)c,q 0 0 o Heated/Cooled SF---~r"'f" __
I
RE# / 7 / '-t I '1 -OO"J o
Non-Heated/Cooled /1.~
• Class of Work: ~ew □Additi on □Alte ration □Repair □Move □Demo □Pool □Window/Door
• Use of existing/proposed structure(s): □Commercial ~Residential
• If an existing structure, is a fire sprinkler system installed?: □Yes □No
• Will trees be re oved in association with ro osed ro·ect? □Yes must submit se arate Tree Removal Permit o
Describe in detail the type of work to be performed: Xf'\ $f0-ll0-t-ton ~ ;t::>,f\JG...C...c..t -s:1e(\CJ-<\.ct_ O~ /1~r-t-h
3fcie....&~'-:-1..cu;-o{. The.. ~e0u<:5 l,,v)~\ ~e-..Z-A vJ oa;Lf ~ tfo-ocr::: clo:8".,, \ 'T' .5
Florida Product Approval# __________________ for multiple products use product approval form
Property Owner Information
Name BCl,O>,-\tL, Do ,t\ S. Address_lf~°<-•-:>-~27=-~c~ex::~--=,..£,...,~ac ... / ________ _
City Af(r,, em''L, 3 e e t:.h State PC:= Zfp (~d« -? 3 Phone 7':0'i 2-S::.5 ¥/..:2 ,::;
E-Mail bo,,,co,,. \Lol I q 858-<fj {)JO-,~ t, cocn
Owner or Agent (If Agent, Power of Attorney or Agency Letter Required) __________________ _
Contractor Information
Name of Company /\J/4: Qw DCC --B, 21 Id '2-C Qualifying Agent _____________ _
Address ___________________ City _______ State ___ Zip _____ _
Office Phone ______________ Job Site Contact Number ______________ _
State Certification/Registration# ________ E-Mail _____________________ _
Architect Name & Phone# _________________________________ _
Engineer's Name & Phone# _________________________________ _
Workers Compensation Insurer _______________ OR Exempt o Expiration Date _______ _
App lication 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 wo rk will be performed to meet the standards of all the laws regulating
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
R~~_:-~_:>F COMMENCEMEN_T_. ~h_"A~-----------
(Signature of Owner or Agent) (Signature of Contractor)
t--d Signed and sworn to (or affirmed) before me this L day of Signed and sworn to (or affirmed) before me this __ day of
/{c y1;..""'~-e.., , ,2-0a:Q , by v-. -----~--~by __________ _
[ I Personally Known OR
I 'fProduced Ident ification
Type of Identification: F=-L
t:')( f
.--i?~~~'-i:--CHRISTY RIGNEY fa(~-·/ Commission# GG 190226
"-,J~~;,-~' Exp1res May 31, 2022 ] Personally t<nown OR
•-,,~r.t,';?/ Bonded n,ru Troy f ain lnsurance a00-385-7019 ] Produced Identification
(Signature of Notary)
l -o ype of Identification: _____________ _
s -;)-1 -;mq-1
FNCE20-0123\NOTICE OF COMMENCEM ENT
State of _F_lo_ri_da ___________ _ Tax Folio No. _____________ _
County of _D_u_v_al __________ _
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property, and in accordance with Section 713
of the Florida Statutes, the following informat ion is stated in this NOTICE OF COMMENCEMENT.
Lega l Description of property being improved: _3_1_-1_;6_1_7_-_2S_-_2_9_E ____________________ _
R/P OF PT OF ROYAL PALMS UNIT 2A LOT 23 B LK 10
Address of property being improved: 423 lrex Road Atlantic Beach Florida 32233
Gen eral descr iption of improvements: Installation of privacy fencing on north side of the yard. The fencing will be IAW
O rdinance 90-09-208 Exhibits A & B.
Owner: Barak Davis Address: 423 lrex Road Atlantic Beach FL 32233
Owner's interest in sit e of the improvement: _1N_C_R_E_A_S_E_P_R_1v_A_C_Y __________________ _
fee Si mple Trtleholder (if other than owner): _________________________ _
Name: ___________________________________ _
Contractor: OWNER/BUILDER , SAME AS OWNER
Address:------------------------------------
~
0
8
Telephone No.: __________ _ Fax No: -------------
Surety (if anv)_N_/A _____________________________ _
Address: ________________________ Amount of Bo nd$ ____ _
Telephone No: __________ _ Fax No: ____________ _
Name and address of any per son making a loan for the construction of the improvements
Name:_N_I A __________________________________ _
Address:-----------------------------------
Phone No: ____________ _ Fax No: ____________ _
0 ;:o
Ill ;,:;
~
IO
ti)
u, u, _u,
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other doc uments may -
be served: Name: Amanda Suter -----------------------------------------
Address: 423 lrex Road Atlantic Beach FL 32233
Telephone No: _(3_6_0_) 5_2_0_-1_0_07 ______ _ Fax No: ____________ _
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2) (b), Florida Statues. (Fill in at Owner's option)
Name: NI A ------------------------------------------
Address: ______________________________________ _
Te lephone No: __________ _ Fax No: ___________ _
Expiration date of Notice of Commencement (the expiration date is one (1) year from the date of recor ding unless a different date is
specified):
THIS SPACE-FO_R_R-EC_O_R_D_E_R-'S_U_SE_O_N-LY _____ O_W_N_ER-b------,,-~----,,--~-+---=--------------
_ .. ,~~~-~%·,. CHRJSTY RIGNEY
[~f ·A?;i Commission# GG 190228
,~-~:~,. Expires May 31, 2022
'<~~i;i~?J··· Bonde<! Thru Troy Fain ln;uraiiee 800-385-701~
~
<;. -
Signed; ~ f«_~t!=+-Date: / l -;). -/)-,() iJ-0
Before m~ day of;vc;v-ei,., h er-1 ;;.l-C?-o in the County of Duval, State
Of Florida , has personally appeared--'B'-a:.-'-'-rQ,__,,_,__k,_,.__--=-P---'-->"L"--lf'-; s:.,__ ________ _
Notary Public at large, State of Florida, County of Duval.
My commission expires: fi -.3 /-;l0;2.,;;)....
Personally Known: __ -=-=-=--:=-----,-,-=----=----:::=--=--c: or
Produced Identification: R-vL 7> I 2-0 -06 ( -85-l(f 7-D !?cf <;;-J..7-'J-OJ. 7
FNCE20-0123
(SIGNEO)
fO\JNO I /2" !Roi.
PIPE (NO I 0 .)
. e-' >-~
"'
-~-~
I ..
"t:: 0 gl :r: :,
0,:: .! 0
~. X ~
L:.j "' >
p;: ~ ---
I.
SURVEY NOTES
..-,,...
"' ..
0
D
in
"' 0 co
s:
~
0
io
;... ,.,
z
~ll~INE-
LOT 22 BlOOC 10
----25'---
1----29.r---1--l
I.OT!!
OLUC'K to
31.7'
11.7'
'
3, 2' CONC. ~
WALK . ·••·.. ~
_:. ~ .
~
9 8' --1--t--;.;;' •.;::J!;._' ---'._.;"'
.. -~;1 · .. ·-::· .•16 .-;-~ ~ .·•··• ·~ ~1·
, ~ (•,C~c •oRt,J( ., : : "t,.,' • •• ciw. !cc:;c -· :: ~ N ~i~~-:: .. ~ .,_:1-~ ~~~: /~·.--=:~~: ,~
.... ,.;
,u I
COIIC.
IOVtlD 1/2" IRON
P,PE (NO 1.0 )
,;,..1 oo·
I.OT 2,1
fll CX"K 10
l fJ I !. I
UL(ll'I< I U
CONCRETE DRIVE CROSSING OVER PROPERn' LINE ON THE WESTERLY SIDE OF LOT.
THERE ARE FENCES THAT CROSS INTO THE 5' UEJD.E.. AT REAR OF PROPER TY.
lol t
111 l h f.. H)
SURVEYORS CERTIFICATE /TARGET
I HERfBY CEllllfY THAT THIS BOUNDARY SURVEY
IS A TRUE AtlDCORRi:CT REPRESENTATION OF A
SURVl:Y PREPARED UNOER !JYOIRECOON
NOT VAUD wm,our All AUTHENT ICATED EU:ClRONIC
SJGNA TURE ANO AUTHElfflCA I ED ELECT RONIO SEAi.,
OR A RAJSE.0 EJ.IBOSSED SEAl A/oJO SIGNATURE.
-___ Qsborne
Olg11,llfy 1'9:ntd t,,, ~1u1tl1' Oib.o,nr
OH C11 -JiCt-M1ll10lbo,11.ir.a .. 1m,.r
Sutv""'nq.ll(,ou.
cM'w.,l'"(1u,f\bi.Jte,t•19,r1~Ml.
<•U\
O.-C" ?0l~l!S2.!_13i.\1. l)-Oof'OO'
l<ENNETH J OSBORNE
Jll-t0►£.sSIOtl AL SCJJ.IV£'VOR ANO MAPPCA dS.. I§
l_ SURVEYING,ILC
LB #7893
SERVING FLORIDA
6250 N MILIT A~Y TRAll, SUITE 102
WEST PALM BEACH, FL 3J407
PHONE (561) 64(>-4800
STATEWIDE PHONE (800) 2,s.,507
STATEWIDE FACSIMILE (800! W-0576
WEBSITE. hltp.//larr;elwrveyin!) nel
Revision Request/Correction to Comments
City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
0 Revision to Issued Permit OR D Corrections to Comments
**ALL INFORMATION
HIGHLIGHTED IN
GRAV IS REQUIRED.
PERMIT#: FNCE20-0123
Date: 11/10/2020
Project Address: 423 IREX ROAD ATLANTIC BEACH FLORIDA 32233
Contractor/Contact Name: AMANDA SUTER ---------------------------------
Contact Phone: (360) 520-1007 Email: AMANDANICOLESUTER@GMAIL.COM -------------
Description of Proposed Revision/ Corrections:
SUBMISSION OF THE REVOCABLE ENCROACHMENT AGREEMENT FORM .
I_A_M_A_N_D_A_S_U_T_E_R ________ affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
•~roposed revision/corrections add additional square foo~e to origi nal submittal?
~o 0 Yes (additional s.f. to be added: /\.)J )
• Wiu(roposed revision/corrections add additional increase in buildi7 A lue to original submittal? ~~. El*Yes (additional increase in building value: $ /\) ) {Contractor must sign i f increase in va luation)
~ *Signature of Contractor/Agent: ~~ ~
7
(Office Use Only)
i!{Approved D Denied D Not Applicable to Department Permit Fee Due$ ______ _
Revision/Plan Review Comments ______________________________ _
Department Review Required:
Building
Planning & Zoning
Tree Administrator
Public Works
Public Utilities
Public Safety
Fire Services
Reviewed By
Date
Updated 10/17/18
REVOCABLE ENCROACHMENT AGREEMENT
City of Atlantic Beach **ALL INFORMATION
HIGHLIGHTED IN GRAY
800 Seminole Road, Atlantic Beach, FL 32233-,A_,,, Q rn,, rf' 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 "CllY" and
AMANDA SUTER 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 FENCING INSTALLATION/ADDITION/EXTENSION
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 423 IREX ROAD ATLANTIC BEACH FLORIDA 32233
• In the event it is necessary for the CITY or the City's approved rep resentative 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 t his 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 assumed by the USER.
Property Owner/Agent (signed in presence of Notary Public)
STATE OF FLORIDA, COUNTY OF DUVAL
The foregoing instrument was acknowledged this
/_,,J-,
/ t) day of NO Vt r ·n b c., l ,20 2 0
, who personally appeared before me and
(printed name of Signer)
acknowledged that he/she sig ned the instrument voluntarily for the purpose expressed in it.
I J I),) , .... ~;~~~~if,·•... KATHERINE PERRY
-Lt<--=-...!.Y-_------,~-'--'-1...=.,, '-A.==-:J.-------------,11-i,-~--11}/f ~ Commission# GG 280740
Signature of Notary Public, State of Florida li~·JJ Expires February 6, 2023 ·-.;r,~·f:f~?~•· Bonded Thro Troy Fain Insurance 800-385-7019
[ ] Personally Known
[ !.f1"roduced Identification (Type) F I O I
Department Approval:
Scott Will iams, Public Works Director
H:\Applications & Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Rev i sion Date: 8/31/18