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700 Amberjack Ln FNCE20-0003 Approved, Not Issued rS.:Lli,-, City of Atlantic Beach APPLICATION NUMBER �' .-..4,_ Building Department (To be assigned by the Building Department.) j 800 Seminole Road * `,� _ AtlanticBeach, Florida32233-5445 T1,�e E-? J_, `)��—�Phone(904)247 5826 Fax(904)247 5845!„�"19;- E-mail: building-dept@coab.us Date routed: , ZD City web-site: http:/lwww.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 7(() Fyi2sPv._ Department review required Yep. No dingi �/Applicant: C (�) 3 ���� 1.1-31. Planning &Zo ilai Tree Administrator Project: CC ( r � (Public Worms Public Uti i ies 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: ��pproved. ❑Denied. Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING / — —.3U Reviewed by: I 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. UNot applicable Comments: Reviewed by: Date: Revised 05/19/2017 fors Building Permit Application Updated 10/9/18 `i City of Atlantic Beach Building Department **ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY Phone: (904) 247-5826 Email: Building-Dept@coab.us IS REQUIRED. Job Address: loo frtk .0 AU< ( f- Permit Number: ' l\C_E ZO 0003 Legal Description RE# 17 ) 125—66 4 d Valuation of Work(Replacement Cost)$ 11 600 ,CIO Hated/Cooled SF Non-Heated/Cooled • Class of Work: ENew ❑Addition ❑Alteration Cl/Repair ove ❑Demo ❑Pool ❑Window/Door • Use of existing/proposed structure(s): ❑Commercial esidential • If an existing structure, is a fire sprinkler system installed?: ❑Yes QNo • Will tree(s)be removed in association with proposed project? ❑Yes(must submit separate Tree Removal Permit) o Describe in detail the type of work to be performed: Wt,p5cg. F�McE- 4(,ejt. 7 ye.00-(Y Florida Product Approval# for multiple products use product approval form Property Owner Information Name �c.1,0,J JG^)6.--S Address 70c) 4Nigg/2JP,f LA) City p 4-,41-AJ l (C g f State rL Zip 32233 Phone 61011 — 1T'q7— 657 E-Mail Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company Qualifying Agent Address City State Zip Office Phone Job Site Contact Number ;; r State Certification/Registration# E-Mail Architect Name& Phone# Engineer's Name&Phone# r;, Workers Compensation Insurer OR Exempt❑ 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 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 RECORDI /�OUNOT E OF COMMENCEMENT. gna Owner or Agent) (Signature of Contractor) Signed and sworn to(or affirmed)before me this 3 1 day of Signed and sworn to(or affirmed) before me this day of C. , -. ,111/45‘t ,drJ (-\e.., , ,by Signature of Notary) (Signature of Notary) .lr�'W Notary Public Stated Florida Personally Known OR at' [ ] Personally Known OR Joy E Jones [ ]Produced Identification .0,- f My Commission GG 002072 [ ] Produced Identification 1.4 Type of Identification: ar� Expires 06/17/2020 Type of Identification: ALL Owner Builder Affidavit **HIGHLI HIGHLIGHTED ON "s'Fir, HIGHLIGHTED IN J I `; City of Atlantic Beach Building Department GRAY IS REQUIRED. 800 Seminole Rd, Atlantic Beach, FL 32233 ,.,.Ji >'� V Phone: (904) 247-5826 Email: Building-Dept@coab.us 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 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. CONTACT THE BUILDING DEPARTMENT(904- 247-5826 OR BUILDING-DEPT@COAB.US) 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. Job Address: O 4tg2J4Ck LA) G ,L Owner Name: I OT JoN Es Phone Number: 0 --- 4 1p� 7-r857 Mailing Address: ZO AM, ,Q-Lk- W (.-y: 'T/C tiara/State: FL. zip: 322 5� Notarized Signature of Owner 2----7.< The fo oing instrument was acknowledged before me this 3 ) day of c_ , 20k 9, in the State of Florida, County of `V)�\IGk.,\ ' ' 1 Sign ure of Notary Public r Notary Funic Stated Florida Irilk Joy E Jones My Commission GG 002072 rlore Expires 0 /17/202o ersonally Known OR [ ] Produced Identification Type of Identification: Updated 10/24/18 rs.L/r,, City of Atlantic Beach APPLICATION NUMBER /J ti\ Building Department (To be assigned by the Building Department.) z- 2 800 Seminole Road - --' Atlantic Beach, Florida 32233-5445 EC -' D�� \ v Phone(904)247-5826• Fax(904)247-5845 1 / �•� r'!onto— E-mail: building-dept@coab.us Date routed: "� City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: ---7co i pc spc ,(_ Department review required Yes No (517il�dg____-% Applicant: �(/s) � _ &Z Planning oe Tree Administrator • Project: ( ( E v �blic MAO Public 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. enied. ❑Not applicable (Circle one.) Comments: -1-0 / /- BUILDING fieed S'h'e S$1L k PLANNING &ZONING —'Z (— Reviewed by.,41... Date: ( 9 TREE ADMIN. Second Review: Approved as revised. I !Denied. Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Review: Approved as revised. I !Denied. Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 City of Atlantic Beach APPLICATION NUMBER js o Building Department ECE1�/" (To be assigned by the Building Department.) 800 Seminole Road ��Nn1 .) Atlantic Beach,Florida 32233-5445 AN 09 [u20 4) E-���`' o`� _ � 3 Phone(904)247-5826 • Fax(904)2 84 _ E-mail: building-dept@coab.us Date routed: ' 7.0 City web-site: http://www.coab.us BY: APPLICATION REVIEW AND TRACKING FORM Property Address: Q y 2 �� C tL Department review required Yes No Buildji .g Applicant: ) (ice � _ Planning &Zoe Tree Administrator • Project: CC ublic Work } Public 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. IVI/Denied. ❑Not applicable (Circle one.) Comments: BUILDING PLANNING &ZONING f ,20 Reviewed by1h� Date: / TREE ADMIN. Second Review: A roved as revised. pp Denied.❑ [ [Not applicable PUBLIC WORKS Comments: PUBLIC UTILITIES ( w 1J PUBLIC SAFETY Reviewed by: � Date:J"/,Z FIRE SERVICES Third Review: Approved as revised. Denied. ❑Not applicable Comments: Reviewed by: Date: Revised 05/19/2017 Revision Request/Correction to Comments **ALL INFORMATION HIGHLIGHTED IN 144-540>.4 City of Atlantic Beach Building Department GRAY IS REQUIRED. 800 Seminole Rd, Atlantic Beach, FL 32233 7� Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: Floce20 OOcx I Revision to Issued Permit OR [ J'Corrections to Comments Date: 3 / 0/Z0 Project Address: '700 I\fr\A-t ERS Ac1-{ Contractor/Contact Name: O�k-)I�`-1 t— . t Ii C74 _.?©(\ e S Contact Phone: —i Cir ` 3857 Email: • Description of Proposed Revision/Corrections: R e_vocciSate affirm the revision/correction to comments is inclusive of the proposed changes. (printed name) • it proposed revision/corrections add additional square footage to original submittal? ❑ Yes(additional s.f.to be added: ill proposed 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) LJ Approved ❑ Denied ❑ Not Applicable to Department Permit Fee Due$ Revision/Plan Review Comments De nt Review Required: Buildi nning&Zoning—' Reviewed By Tree Administrator �bl_ic Works____—'�— Public Utilities 3i1-2) Zc� Public Safety Date Fire Services Updated 10/17/18 LL Revision Request/Correction to Comments **HIGHLIG INFORMATION �,*4.k HIGHLIGHTED IN City of Atlantic Beach Building Department GRAY IS REQUIRED. 1‘ 1.111, 800 Seminole Rd, Atlantic Beach, FL 32233 �j� Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: F-10. ce Z0 DOo Revision to Issued Permit OR L*'J Eorrections to Comments Date: 3 /I 0/2_0 G Project Address: "700 RCS.< Contractor/Contact Name: o VA 1\)E C. L to 1 ©(\ e- Contact Phone: -i'7 ` 38S'7 Email: Description of Proposed Revision/Corrections: R evM_PiSole K_) Lr oo-r � 5Pce,K_S I affirm the revision/correction to comments is inclusive of the proposed changes. (printed name) • i proposed revision/corrections add additional square footage to original submittal? - ❑ Yes (additional s.f.to be added: sr ill proposed 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) Approved ❑ Denied ❑ Not Applicable to Department Permit Fee Due$ Revision/Plan Review Comments De nt Review Required: Buildi ning&ZoniReviewed By Tree Administrator �ublic cs�—� Public Utilities J Z-1_ Public Safety Date Fire Services updated 10/17/18 MAP SHOWING SURVEY OF LOT 1, BLOCK 2, ROYAL PALMS UNIT ONE AS RECORDED IN PLAT BOOK 30, PAGES 60 and 60A OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. �A'�( S85'48'08"E 31.47' FIELD ) 7 FOUND 1/2'IRON p 31..5'4' ��G+ . PIPE, NO C•'. S85'20r02�r 32, FOUND 1/4'IRON O v . 70PIPE,NO CAP '� � c 4, TO �9y�0 ,......•_. % \ �S • �� SX ASR �� // ( N S �" to Vi 0006,�?AF OA(r o� e ,� N O `\ Q 25'r ro "90 5,..- 6./ _ O RESTR ,S ��O _9 0) \ •'s •S�'J 13 O LOT210 • FOUND ° "X'1�11T O2F % �•h,°� O N II. ' 1o.s' Qin s. 46 9 '1- . �c6` --.12 O o10 v P �i 0 1 w Z wo ''o`"� �h,o 0 = O s. O !I/iq 263y __ �' - 1 EMENT FOR 0) 1111 0.1"� l_---- �RAINA� FOUND '` r._ _ ND unuT s -P .N IRON _— ��3 _ .� PIPE.NO cqP _ o.r __ N$5 n Ilii' —— ,_ '2v•��nlsl 4'CHAP'LIN.e(FENCE ��. LOT 15 B L O ( N85'36'2g yy 100.45' FIELD - 8 __� 0.3 il FOUND 1/2'IRON I -Li_ r PIPE,NO CAP NSWK LOT 16 2 I 261 , 1 NOTES II 1. THIS IS A BOUNDARY SURVEY. 2. BEARINGS ARE BASED ON THE WEST LINE OF LOT 1, BLOCK 2 BEING NORTH 04'39'58" EAST, AS PER PLAT. I,, ., t• r 14 P-... 3. BUILDING RESTRI LINE SHOWN AS f i7 4✓ =..� PER PLAT. 4. EASEMENT SHO 4f04/1/1),i.% • . MAR 10 , 020 d ply Fip vclOP Y: Fpq ,1:110 40 SCALE: 1" = 20' THIS PROPERTY SHOWN HEREON APPEARS TO LIE IN FLOOD ZONE "X" (AREA OUTSIDE THE 500 YEAR FLOOD PLAIN) AS WELL AS CAN BE DETERMINED FROM THE FLOOD INSURANCE RATE MAP COMMUNITY PANEL THIS SURVEY WAS MADE FOR THE BENEFIT No. 120075 0001 D, REVISED APRIL 17, OF FRAN IS GARNETT HARRISON FORE. 1989 FOR THE CITY OF ATLANTIC BEACH, DUVAL COUNTY, FLORIDA. N i --i \ 'NOT VALID`ATHOUT THE SIGNATURE AND THE DONN W. BOATWRIGHT, P.S.M. ORIGINAL RAISED SEAL OF A FLORIDA UC -.D FLA. UC. SURVEYOR AND MAPPER No. LS 3295 SURVEYOR AND MAPPER.' FLA. LIC. SURVEYING Sc MAPPING BUSINESS No. LB 3672 CHECKED BY: BOATWRIGHT LAND SURVEYORS, INC. DRAWN BY: SWC 1500 ROBERTS DRIVE DATE: NOVEMBER 15, 2012 FILE #: 2012-0931 JACKSONVILLE BEACH. FLORIDA 241-8550 SHEET 1 OF r • MAP SHOWING SURVEY OF LOT 1, BLOCK 2, ROYAL PALMS UNIT ONE AS RECORDED IN PLAT BOOK 30, PAGES 60 and 60A OF THE CURRENT PUBLIC RECORDS OF DUVAL COUNTY, FLORIDA. REVISION It, BP#L-//l.Eo "ocr0 ( 585'48'08"E 31.47' HELD ) (5'07/6„ DATE 3 f/70,22-6'- FOUND 1/2"IRON p 31:54' O%x, SIGNED /' ' PIPE NO C _ S8S�2O'O2"E FOUND NO CAP �O�O yy� of - �O/& \ rS )_ Qtr. J)D1 __-- . s ye. '3/ JOB COPY {o( N 6' X R/. "C' T o O0.501.5.> .9 ,t� OqG Off^ val.;:w -Z5, t‘04 nlO /\ O RESTRIC 25'BUI.,! „ ,Q / NO C_ F . •.)6,..•,..5•,>.. o re, 13 Id li o 12 O 9.5: /1 .*T LOT 2 `,,;,5 - 12.0 ,c� ogcpY�, �( - ip w ,• AG r�, J 't,%, FOUND Do 1 I ,OyQ lP���O 's, �'•�O�\ ,. X"CUT a '� 0` �0�� 1 1n 2 ;�,�I - > °oo LA .`,2,:, ' 10.5' Cii, s. �o�"9 *� �c`�� �1 ,, O W s OPF >C� 'S';. cy,l 0 O '0 O v. 3, O < Wo V 26. N Uy Q N� } �t 6� -0:31. % rn m in o.r r --- )::9!__ --- :6: tRAINA� EMENT FOR o FOUND .1 2'IRON — 'num, ———— ND UTILITIES S'2O'O2"�,7 4'CHAIC'UNK FENCE /� LOT -18 B ? L 0 ( N8 '36'29�W 100.45 FIELD 99-8 --� _0 3 7 O'FOUND 1/2'IRON I C . PIPE,NO CAP LOT^ Ne.h/ 16 2 I 26' I _ 1 I NOTES 1. THIS IS A BOUNDARY SURVEY. 2. BEARINGS ARE BASED ON THE WEST LINE �. OF LOT 1, BLOCK 2 BEING NORTH 04'39'58" �a' rte;C;/'� E II/E EAST, AS PER PLAT. 3. BUILDING RESTRICTION LINE SHOWN AS ._, PER PLAT. I1H MAR 10 2020 4. EASEMENT SHOWN AS PER PLAT. i l 1 `1 BY: — q '°� I SCALE: 1" = 20' THIS PROPERTY SHOWN HEREON APPEARS TO LIE IN FLOOD ZONE "X" (AREA OUTSIDE THE 500 YEAR FLOOD PLAIN) AS WELL AS CAN BE DETERMINED FROM THE FLOOD INSURANCE RATE MAP COMMUNITY PANEL THIS SURVEY WAS MADE FOR THE BENEFIT No. 120075 0001 D, REVISED APRIL 17, OF FRAN,cIS GARNETT HARRISON FORE. 1989 FOR THE CITY OF ATLANTIC BEACH, \ DUVAL COUNTY, FLORIDA. 1 Nk_ "NOT VALID WITHOUT THE SIGNATURE AND THE DONN W. BOATWRIGHT, P.S.M. ORIGINAL RAISED SEAL OF A FLORIDA LIC' 'D FLA. UC. SURVEYOR AND MAPPER No. LS 3295 SURVEYOR AND NAPPER: FLA. LIC. SURVEYING & MAPPING BUSINESS No. LB 3672 CHECKED BY: BOATWRIGHT LAND SURVEYORS, INC. DRAWN BY: SWC 1500 ROBERTS DRIVE DATE: NOVEMBER 15, 2012 FILE #: 2012-0931 JACKSONVILLE BEACH, FLORIDA 241-8550 SHEET?OF Revision Request/Correction to Comments **ALL INFORMATION ` :f HIGHLIGHTED IN City of Atlantic Beach Building Department GRAY IS REQUIRED. 800 Seminole Rd, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: I IOC e-3- 0UO3 Revision to Issued Permit OR Corrections to Comments Date: 3 A Project Address: `700 Re'{ Contractor/Contact Name: O W f�C,-2._ E, L n4 V©n P -. Contact Phone: CI - ` 38S'7 Email: • Description of Proposed Revision/Corrections: ReVQ QE-,0 LP`Z00- - Loi se7"6AC'.KS affirm the revision/correction to comments is inclusive of the proposed changes. (printed name) • i proposed revision/corrections add additional square footage to original submittal? ❑ Yes (additional s.f.to be added: ill proposed 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) Approved ❑ Denied ❑ Not Applicable to Department Permit Fee Due$ Revision/Plan Review Comments De•. ii -nt Review Required: Buildii• �w-- - -•- •-- /%i iii. �Pt�nning&Zoning Reviewed :y Tree Administrator MAR 11 202) � Public Utilities --/g -2.0 Z Public Safety BY: Date Fire Services Updated 10/17/18 REVOCABLE ENCROACHMENT AGREEMENT City of Atlantic Beach **ALL INFORMATION HIGHLIGHTED IN GRAY 800 Seminole Road,Atlantic Beach, FL 32233 IS REQUIRED. .-EJa3f 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 Elliot Daniel Jones 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 Fence Replacemet 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 700 Amberjack,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 Iia it s are 40 umed by the USER. /� 2`;'24 40000W l Property Ow Date• signed in presence of Notary Public) STATE OF FLORIDA, COUNTY OF DUVAL The foregoing instrument was acknowledged this 4544 day of F.QIt r1 , 20 tJ , by , who personally appeared before me and •rinted name of Signer) ac owl-aged that h- he signed the instrume you,^t r;l fir±-6--Aaciwimiorailsed in it. 4' ice,= RUSSELL E GRIMES ., MY COMMISSION#GG 172929 �•••• a- EXPIRES:January 7,2022 Department Approval: 'FOR F�•�" Bonded Thru• Public Undenvdters Signature of Notary P lc, State of Florida personally Known ,/‘/Y/2-1,- 4 Scott Pub iks Director [ I Produced Identification(Type) Williams, V�itT•r� H:\Applications&Forms\Word Documents\20180831 Revocable Encroachment Agreement.docx Revision Date:8/31/18 s�:LyrCity of Atlantic Beach APPLICATION NUMBER 3tT,y. Building Department (To be assigned by the Building Department.) pCY:), 800 Seminole Road / `)o03. Atlantic Beach, Florida 32233-5445 T�)e E? Phone(904)247-5826 • Fax(904)247-5845 t E-mail: building-dept@coab.us Date routed: 1 ZD City web-site: http://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: ' 700 e)G AN<- De artment review required Yes No Building Applicant: 0 L3 � _ Planning &Zoe Tree Administrator Project: CC ( ublic Work-0 Public Utiliti�- 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: BUILDING �J PLANNING &ZONING Reviewed by: �/"�� Date: /-/O-20 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