_____________________________________________
_____________________________________________
____________________________________________________________________________
___________________________________
_________________________
_________________________
________________________________________________________
City of Boynton Beach
Planning & Zoning Division
EASEMENT CONSENT
To: _____________________________________________
Name of easement holder
Address: _____________________________________________
Gentlemen:
I am the record titleholder of property located at ____________________________________. I propose to
apply for a permit from the City of Boynton Beach to construct or install a ______________________________
in the ____________________ easement on my property, legally described as:
Lot _______________ Block _____________ Subdivision ____________________________ or Metes &
Bounds ____________________________________________________________
Please complete the section below indicating your approval or disapproval of this work.
I understand that you will not be responsible for repairs to, or replacement of, any portion of the above
referenced improvement and that any removal or replacement of this improvement necessary for your use or
access to this easement will be performed at my expense or my successors in interest.
Owner's Signature & Date
Owner’s Phone #
___________________________________
Owner's Signature & Date
ACKNOWLEDGEMENT:
I/We (agree) (do not agree) to the proposed improvement under the circumstances described on pages 3
and 4 of this document.
Name of easement holder(s)
By: ____________________________________ Title: ______________________________
Date: __________________________________
(1 of 4)
3301 Quantum Blvd, Suite 101, Boynton Beach, FL 33426 Phone: (561) 742-6260 Fax: (561) 742-6357
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EASEMENT HOLDERS
To assist you in identifying potential easement holders, the following list is being provided. THIS LIST
IS NOT INCLUSIVE AND OTHER ENTITIES MAY HAVE EASEMENT RIGHTS. It is the applicant’s
responsibility to identify all easement holders.
NOTE: A copy of a survey must be provided with each consent form when submitting to the
easement holder.
CABLE: GAS:
Comcast Florida Public Utilities
M-F 8AM-5:30PM, Sa 9AM-1PM M-F 8AM-5PM
3960 RCA Blvd., Suite 6002 Phone: 561-832-0872
Palm Beach Gardens, FL 33410 Fax: 855-212-5011
Email: Daniel_Tiburcio@comcast.com Attn: Engineering
Attn: Daniel Tiburcio Email: Engineering-wpb@fpuc.com
Comcast PBC Construction Dept. 401 S Dixie Hwy.
(Allow 1 week for return email) West Palm Beach FL 33401
*Do NOT send request via U.S. mail (Mailing: PO Box 3395, W P B FL 33402-3395
include self-addressed, stamped envelope)
ELECTRIC: TELEPHONE:
Florida Power & Light Company BellSouth Telephone / AT&T
M-F 7:30AM-4PM M-F 8AM-5PM
Phone: 561-616-1601 AT&T Engineering Department
Fax: 561-616-1625 321 SE 2
nd
Street, Delray Beach, FL 33483
9329 S Military Trail Fax: 561-272-8695
Boynton Beach FL 33436 -2901 Email: g30576@att.com
(www.fpl.com) Attn: Cassandra Hendrix
Note: No longer accepting walk-ins requests
WATER/SEWAGE:
M-F 7:00AM-4:00PM
City of Boynton Beach Utilities Dept.
Phone: 561-742-6400
Email: easementconsent@bbfl.us
124 E Woolbright Road
Boynton Beach FL 33426-6040
(2 of 4)
3301 Quantum Blvd, Suite 101, Boynton Beach, FL 33426 Phone: (561) 742-6260 Fax: (561) 742-6357
S:\Planning\Forms\P&Z Applications\Current Style\P&Z Permit Application & Forms\Easement Consent & Removal Agreement-forms.doc
10/2014, 1/2018
________________________________________________________________________
_________________________________________________________________________
City of Boynton Beach
Planning & Zoning Division
REMOVAL AGREEMENT
DATE: PERMIT NO:________________
WHEREAS, _______________________________ (hereinafter referred to as “Owner(s)”
(Print)
is/are desirous of construction or installing a ____________________________________in a portion of
the ________________________________ easement on my/our property, the legal description of this
property being as follows:
Lot _______________ Block ______________ Subdivision ________________________ or Metes &
Bounds ________________________________________________________
WHEREAS, the Owner(s) does/do covenant that they are the fee simple owner(s) of the property; and
WHEREAS, the above is to be erected for the use and enjoyment or proper functioning of the property
and special aesthetics;
NOW, THEREFORE, in the consideration of the City of Boynton Beach (“City”) not immediately enforcing
its rights or the rights of any others, now existing or which may in the future exist, against the Owner(s) or
the property, the Owner(s) hereby agree(s) with the City to remove, at no expense to the City, the
Easement holders, or the beneficiaries of the easement, the above described improvement from the
property, within thirty (30) days of written notice addressed to them or their successors in interest, at:
ADDRESS: _______________________________________________________________
notifying them that said improvement is inconsistent with the use of the Easement. It is agreed by the
Owner(s) that the improvement shall be as depicted on Exhibit “A” and filed with the City of Boynton
Beach Planning and Zoning Division, and that no other construction shall be in effect in said Easement.
It is agreed by the parties, hereto, that this Declaration will be recorded at the expense of the
Owner(s) in the Official Records of Palm Beach County, Florida and that this Declaration shall be a
covenant running with the land and be binding upon the heirs, personal representatives, grantees,
assigns and successors in interest of the Owner(s).
Owner(s) shall immediately remove the improvement permitted herein in the event that the City or
Owner(s), or both, are challenged with respect to the City’s authority to authorize the placement of said
improvement in the Easement or a claim of damages is made as a result of the placement of said
3301 Quantum Blvd, Suite 101, Boynton Beach, FL 33426 Phone: (561) 742-6260 Fax: (561) 742-6357
S:\Planning\Forms\P&Z Applications\Current Style\P&Z Permit Application & Forms\Easement Consent & Removal Agreement-forms.doc
10/2014, 1/2018
improvement in the Easement. In the event that the City and/or Owner(s) are challenged with respect to
the placement of said improvement in the Easement, or a claim for damages is made as a result of the
placement of said improvement in the Easement, Owner(s) shall indemnify, defend, and save the City
harmless against and from said challenge.
Upon the vacation, abandonment or discontinuance of the Easement, this Declaration shall immediately
and automatically terminate and be of no further force and effect.
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGED on this _________________ day of
___________________, ________.
WITNESS:
________________________________ ___________________________________
Owner’s Signature
________________________________ ___________________________________
Owner’s Signature
________________________________
Owner’s Phone #
STATE OF FLORIDA
COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this ___________________ day of
_________________________, ________, by ___________________________________
(Name of Person Acknowledging)
who is personally known to me or who has produced ______________________________
(Type of ID)
as identification and who did/did not take an oath.
(Signature of person taking
acknowledgement)
(Title or rank)
(4 of 4)
(Name of Officer taking acknowledgement
typed, printed or stamped)
(Serial number, if any)
SEAL
3301 Quantum Blvd, Suite 101, Boynton Beach, FL 33426 Phone: (561) 742-6260 Fax: (561) 742-6357
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