Fillable Permit Center Note: Easement Consent re uests are (Florida)

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Permit Center Note: Easement Consent re uests are (Florida)

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Note: Easement Consent re
q
uests are not a right, but a privilege that may be approved or denied by the
Easement Holder during the review process. Please allow sucient timefor the Easement Holder to process
your re
q
uest.
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2300 N Jog Road
West Palm Beach, Florida 33411
(561) 233-5130
(561) 233-5144 FAX
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ADA al
ternative documents
available by c
alling
(561) 2
3
3-5100
P
CF#0058 Rev. 6/1
7
/20
FPL
Boundaries
For
Easements
From
:
Martin
County
Line
Blue
Heron
Blvd
To
:
FPL
Tel
:
561
-
575
-
6340
Fax
:
561
-
575
-
6333
100
S
Delaware
Blvd
Jupiter
,
FL
33458
Blue
Heron
Blvd
Lake
Worth
Rd
From
:
To
:
Tel
:
561
-
616
-
1601
Fax
:
561
-
616
-
1625
FPL
810
Charlotte
Ave
West
Palm
Beach
,
FL
33401
From
:
Lake
Worth
Rd
Atlantic
Ave
To
:
Tel
:
561
-
742
-
2000
Fax
:
561
-
742
-
2016
FPL
9329
S
Military
Trail
Boynton
Beach
,
FL
33436
From
:
Atlantic
Ave
Hillsboro
Canal
To
:
Tel
:
561
-
479
-
4553
Fax
:
561
-
479
-
4588
FPL
21400
Powerline
Rd
Boca
Raton
,
FL
33433
As
per
Evelyn
Garcia
of
FPL
@
561
-
616
-
1601
and
Debbie
Sisco
@
561
-
616
-
1602
BEFORE
SUBMITTING
FOR
A
FENCE
PERMIT
LOCATED
IN
A
UTILITY
EASEMENT
You
must
complete
the
:
BUILDING
DIVISION
REMOVAL
AGREEMENT
This
must
be
notarized
&
recorded
After
completion
this
must
be
recorded
with
the
:
CLERK
of
the
CIRCUIT
COURT
-
200
W
Atlantic
Ave
Delray
Beach
205
N
Dixie
Hwy
Room
425
West
Palm
Beach
OR
Call
561
-
355
-
2991
for
further
information
You
must
complete
all
5
BUILDING
DIVISION
EASEMENT
CONSENT
FORMS
You
must
have
one
consent
form
for
all
five
utilities
even
if
you
have
no
gas
or
have
a
well
.
The
easement
is
for
the
future
use
of
the
utility
companies
.
The
owner
'
s
signature
on
these
forms
needs
to
be
notarized
.
After
receiving
approvals
&
recording
the
Removal
Agreement
:
Return
the
five
consent
forms
,
the
recorded
copy
of
the
Removal
Agreement
&
2
copies
of
survey
to
the
Building
Dept
,
for
submittal
.
P
B
U
T
S
_
I
a
B
__
e
a
L
o
o
r
__
I
n
t
h
p
o
i
m
p
r
(Si
g
_
_
(P
r
S
T
C
O
S
w
_
_
_
(
N
_
_
(
_
_
(P
P
e
_
_
T
y
P
r
B
O-043-Revi
s
:/Building Ad
m
P
P
B
O:
_
_____
_
UBJECT
P
_
________
_
a
m the rec
o
each Coun
t
_
_______
_
a
sement o
n
o
t
_
_____
_
r
Metes &
B
_
_______
_
n
the event
h
at you or
y
o
rtion of
t
m
p
r
ovemen
t
r
operty ow
n
g
nature of Owner)
_
_________
_
r
int Name)
T
ATE OF FLO
R
O
UNTY OF__
_
w
orn to (or a
_
_______ da
y
_
__________
_
N
ame of person mak
i
_
_________
_
S
ignature of No
_
____________
_
rint, Type, or S
t
e
rsonally Kn
o
_
_________
_
y
pe of Identi
f
r
oduced___
_
s
ed PPM an
m
inistration\
b
P
alm Beac
h
P
lanning, Z
o
B
UILDING
D
_
________
_
P
ROPERT
Y
_
_______
_
o
rd title hol
t
y to constr
_
________
_
n
my prope
r
_
_ Block
_
_
_
B
ounds
_
_
__
_
________
_
that you h
a
y
our comp
a
t
he above
-
t
, necessa
r
n
er or his/h
e
_
__________
_
R
IDA
_
_________
_
ffirmed) and
y
of _______
_
_
_________
_
i
ng statement).
_
__________
_
tary Public ‐ St
a
_
____________
_
t
amp Commissi
o
o
wn ______
O
_
__________
_
f
ication
_
__________
_
b
admin1\PP
M
h
County
o
ning & B
u
D
IVISION
P
_
_______
_
Y
ADDRES
S
_
________
_
der of the
a
uct or insta
l
_
________
_
r
ty, the leg
a
_
_____ Su
b
__
_______
_
_
________
_
a
ve no obje
c
a
ny will no
t
-
referenced
r
y for your
u
er
success
o
_
_________
_
_
_________
_
subscribed
b
_
_____ 20_
_
_
__________
_
_
_________
_
a
te of Florida)
_
___________
_
o
ned Name of
N
O
R Produced
_
_________
_
_
_________
_
dd Form 6/17/20
M
Revisions –
u
ilding De
p
P
ERMIT CE
_
________
_
(Name of easeme
n
S
:
_
________
_
a
bove prop
e
l
l a ___
_
__
_
_
______ in
a
l descriptio
b
division
__
_
________
_
_
________
_
c
tions to thi
t
be respo
n
improve
m
u
se or acc
e
o
rs in intere
s
_
__________
_
_
__________
_
b
efore me th
i
_
_ by:
_
_________
_
_
__________
_
_
____________
_
N
otary Public)
Identificati
o
_
__________
_
_
__________
_
Florida Build
p
artment
NTE
R
_
________
_
nt
holder)
_
________
_
e
rt
y
. I pro
p
_
_____
_
__
the
_
____
_
n of this pr
o
_
________
_
_
________
_
_
_______
__
s improve
m
n
sible in an
y
m
ent and
t
e
ss of this
e
s
t.
_
_
i
s
_
_
_
__
o
n
_
_
A
CK
N
I agre
circu
m
Nam
e
By
:
Title:
Da
te
:
ing Code\PP
M
EASE
M
_
________
_
_
_______
_
p
ose to ap
p
_
___
_
_
___
_
_
________
_
o
perty bein
g
_
________
_
_
________
_
__
_______
_
m
ent, pleas
e
y
way for
r
t
hat any
r
e
asement,
w
N
OWLEDG
M
e to the pro
p
m
stances de
s
e
of easeme
n
_
_
_
M
M
ENT C
O
_
_______
_
_
________
_
p
ly for a bu
i
_
________
_
_
_______
_
g
:
_
________
_
_
_______
_
_
________
_
e
complete
r
epairs to,
o
r
emoval o
r
w
ill be don
e
M
ENT:
p
osed impro
v
s
cribed abo
v
_
_______
_
n
t holde
r
_
______
PBO-043-
F
s Under 2017 FBC\PBO-043
O
NSENT
F
_
________
_
_
_______
_
_
i
lding perm
i
_
________
_
_
________
_
_
__
_
_
___
_
_
________
_
_
_______
_
_
this form. I
o
r replace
m
r
replacem
e
at the ex
p
v
emen
t
, un
d
v
e.
_
_
_______
_
_
_____
_
F
orm100
/
Pa
g
F
OR
M
_
________
_
_
_______
_
i
t from Pal
m
_
_______
_
_
________
_
_
___
_
_
___
_
_
_
_______
_
_
_______
_
understan
d
m
ent of, an
y
ent of thi
s
p
ense of th
e
d
er the
_
_
___
g
e 1 of 1
_
m
_
_
_
_
_
d
y
s
e
Form # 025PBO.043
Revised Date 06/17/20
Page 1 of 2
PALM BEACH COUNTY
PLANNING, ZONING & BUILDING
BUILDING DIVISION
PALM BEACH COUNTY REMOVAL AGREEMENT
Date: ________________________________
PR#: ________________________________
WHEREAS, _________________________________________________________________
(hereinafter referred to as "Owner(s)") are
desirous of constructing or installing a ______________
in a portion of the ______________________________ easement on Owner(s) property, the legal
description of this property being Lot _____ Block _____ Subdivision _______________________
or Metes & Bounds
___________________________________
, as shown in the attached sketch.
WHEREAS, the Owner(s) do covenant that he/she is the fee simple owner 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 consideration of Palm Beach County (“County”) issuing a building
permit for construction of an improvement within an easement to Owner(s), the Owner(s) hereby
agree to remove, at no expense to the County, the easement holders or the beneficiaries of the
Easement, the above-described improvement from the property within thirty (30) days notice by
the easement holder(s) 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 the building permit
application number ________________________________, filed with Palm Beach County
Planning, Zoning and Building Department, and that no other construction shall be in effect in
said Easement. It is agreed by the Owner(s), that this Declaration shall be recorded at the
Owner(s) expense in the Official Records of Palm Beach County, Florida, within ten (10) days of
the date listed above, and that this Removal Agreement 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).
In the event that County 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 protect, defend, reimburse,
indemnify and hold County, its agents, employees and elected officers harmless from and
Form # 025PBO.043
Revised Date 06/17/20
Page 2 of 2
against all claims, liability, expense, loss, cost, damages or causes of action of every kind or
character, including attorney’s fees and costs, whether at trial or appellate levels or otherwise
from said challenge.
Upon the vacation, abandonment or discontinuance of the Easement or the removal
of the improvement within the Easement, this Removal Agreement shall immediately and
automatically terminate and be of no further force and effect.
SIGNED, SEALED, EXECUTED AND ACKNOWLEDGED on this __________ day of
_______________________ 20____.
Witness:
Owner Signature
Owner Signature
STATE OF FLORIDA
COUNTY OF PALM BEACH
The foregoing instrument was acknowledged before me this ___________________________
Date
by ___________________________________
,
who is personally known to me or who has
Name of Person Acknowledging
produced _________________________________________ as identification and who did/did
not take an oath.
Type of I.D.
SEAL
_____________________
(Signature of person taking
acknowledgement
)
__________________ __________________________________
(Name of officer taking
acknowledgement typed, printed
or stamped)
__________________________________________ ______________________________________
(Title or rank) (Serial number, if any)
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Permit Center Note: Easement Consent re uests are (Florida)

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Completed 17 January 2021

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