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DATE: 3/:21/ dY I I CITY OF ZEPHYRHILLS - BUILDING DEPARTMENT RIGHT-OF-WAY USE PERMIT PERMIT# No construction under ground or abov'e ground of any faclll~' shall be accomplished on any City Rlghh of Way without written approval from the City Building Department. Any application for approval of construction operations on any City owned Rlghh of Way shall fumbh a detailed drawing showing the complete scope of the proposed work In triplicate to the office of the Building Official for approv'al prior to the commencement of any work. A cop~' of this permit Is to be kept readily available at the site of the work at all times. PARCEL I.D.# 0':< -;((, ~.;v-O~Il~tJ- 33P~' (!)e>lo CITY ROAD !M;tt,,;1 rt.yr~ce.. dr. DATE LOCATION (Legal Description): Permission Is hereby granted to for the construction lUld maintenance of of subject to the following conditions: 1. The construction and malntenlUlce of such utility shall not Interfere with the property and rlghh of a prior OCCUPlUlt. 2. All work shall be done In keeping with the standards of the City Streeh Department and under the supervision of the City Building Official, who will be notlned at least one day prior to commencement of construction. 3. All materials and equipment shall be subject to Inspection by the C1~' Building Official. 4. During construction all safet). regulations of the Department of Transportation shall be observed ami the City shall be relieved of all responsibility from damage of any nature arising from this permit. Subject to the same terms and conditions, the permit holder ma~' take such safety measures, Including placing and display of caution signs, as It may deem necessary In conduct of construction and maintenance work hereunder. It Is the responsibility of the permittee to place, maintain, and supervise all traffic control and devices. 5. All prlv'ate and all City properly shall be restored to its original condition as far as practical In the opinion of the City Building Official. 6. All underg..ound crossing Installations shall be laid at such depth as ina}' be specified by the City Building Ornclal. 7. The sketch covering the details of this installation shall be made a part of this permit. This permit Is granted with the understanding that the applicant has notified all other utility users In the area conred by the permit and takes full responsibility for lUlY damage Incurred b}' prior Installations as a result of his operations In order that they may safe guard their Interests. 8. It Is expressly' stipulated that this permit b a license for permissive use only and that the placing of facilities upon public property pursulUlt to this permit shall not operate to create or to vest lUlY property right In said holder. 9. Whenenr the City decides to further exploit the City ~Ights of Way', any or all said poles, w'lres, pipes, cables, or other facilities and appurtenances authorized hereunder, shall be Immediately remond from said Rights of Way, or reset or relocated thereon as required by' the City Building Official at the expense of the holder of this permit. 10. The holder shall save and keep the City harmless from any and all damages, claims, or injuries that may occur by reason of the construction, maintenance, lUld operation of said facility. 11. The holder shall complete the requested work within days or this permit shall become nulllUld void. In the ennt the work requested Is not completed upon the expiration date of this permit, the City shall have the right to complete such work and to charge the holder of the permit for all cosh Incurred In completing said work. 12. The holder shall post a cash or surety bond with the City Manager In the sum of $ dollars to guarantee performance of the obligations herein, and to guarantee maintenance of the rlght-of-w-ay described herein for a period of one (1) year following completion of the requested Installation. In the event a surety bond Is posted, the surety bond shall be made payable to the City and shall obligate the surety to hold the City harmless In the event the holder of this permit should fall to mcet any of Its obligations hereunder. The bond shall also Indemnify the City for all court cosh and reasonable attomey's fees In the event legal action Is required to collect on said bond. 13. The permittee shall have a 24 hour emergency contact name and number listed below. SUBMITTED BY: (Permittee) /3itS;UA~ Signature & Title Address Phone APPROVED BY: CITY OF ZEPHY Building Official Date: Utilities Supervisor Date: Public Works Date: ~~. . 3/<1 ~ r City Manager Date: