1732 Atlantic Beach Dr PLRS19-0127 Water System PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0127
�r 800 SEMINOLE ROAD ISSUED: 7/8/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 1/4/2020
MUST CALL INSPECTION • • • / PM FOR • !
ALL ! ' K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • ' + BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
LNOTICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
be found in the public records of this county, and there may be additional permits required from other
ental entities such as water management districts, state agencies, or federal agencies.
JOB ADDRESS: PERMITTYPE: DESCRIPTION: VALUE OF WORK:
1732 ATLANTIC BEACH DR PLUMBING RESIDENTIAL WATER TREATMENT SYSTEM $66.00
TYPE OF
• • GROUP:
169505 1675 ATLANTIC BEACH
COUNTRY CLUB UNIT 02
COMPANY: ADDRESS: '
AFFORDABLE
WATER/KINDER INC 3760 KORI RD JACKSONVILLE FL 32257
• ADDRESS:
SMITH DEBORAH LYNN 1732 ATLANTIC BEACH DR ATLANTIC BEACH FL 32233
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.
OF •
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 0 $0.00
PLUMBING FIXTURES 455-0000-322-1000 1 $7.00
STATE DBPR SURCHARGE 4S5-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
Issued Date: 7/8/2019 1 of 2
ri' V' % PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
r Js, CITY OF ATLANTIC BEACH PlRS19-0127
800 SEMINOLE ROAD ISSUED: 7/8/2019
EXPIRES: 1/4/2020
ATLANTIC BEACH. FL 32233
TOTAL: $66.00
Issued Date: 7/8/2019 2 of 2
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233 n
Ph(904) 247-5826 Fax(904) 247-5845 (F LRStq - Q ( Z 7
JOB ADDRESS: PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$ (30
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
RE-PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan —
Drinking Fountain _ Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well ** **
** SJR WD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.
u Other
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.1 hereby certify that I have read
this application and know the same to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified
or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name
sn"_ lan�I�P � Y1�4- Phone Number
oq—
Plumbing Company N FF0 9 t>A A 1 WA hE9 Office Phon� 2-ni'9? Fax � l —
Co. Address: 3'7(P0 KOP 1 EC'a'd City_ -Ac, or16,1 Je State FL zip 5'22-0
License Holder(Print): m P 1z K 19 � �1 N D t State Ce ification/Registration# 00+D 6 l 8�
Notarized Signature of License Holder eAA
Sworn and subscribed be me this day of
�.�"04. Notary public State of Fkonda
„h ocroe,y M.aevore Signature of Notary P lic
My Commission GG 081383
�o, Expires 02/09/2021
AFFORDABLE WATER
3760 Kori Road Jacksonville, FL 32257
(904) 262-0197 Fax (904) 260-6292
AffordableNlater@AffordableWaterJax.com
NAME DATE
ADDRESS CITY
STATE ZIP PHONE
Water Supply City ❑ Well jInstall Date Loop
Hardness Total (lime)................... g.p.g.
Iron (rust)...... ............... .......... P.P.M. Drain Pipe
pH.......................................
Hydrogen Sulfide....................... Electric Faucet
TDS.....................................
Free Chlorine ........................... P.P.M.
Number of Persons in Family..........
SALT ROUTE Call First J Drop Off ;J Spigot
Location of Equipment
Cross Streets
Area
DESCRIPTION MODEL PRICE WARRANTY
Labor:
Tanks:
Valve Body:
All Parts:
Sub Total .. ......
Sales Tax .Y YY
Permit/county /Non-Taxable
Total........................................... ....... .. . .
Down Payment,....,.................. .. ............... .
Balance Due... .........? .4 ......................
Terms
BUYER'(S') RIGHT TO CANCEL. This is a home solicitation sale and if you do not want the goods or services, you may cancel this agreement
by mailing a notice to the seller. This notice must indicate that you do not want the goods and must be postmarked before midnight of the third
business day after you sign this agreement.
Affordable Water is responsible for repairing equ pment only under warranty and ata charge thereafter.Under no circumstances shall Affordable Water
be responsible for damages to any structure, not damaged by Affordable Water. Specifically, Affordable Water shall not be liable for any damages,
direct or consequential,to persons or property not caused by its own negligence.
The ownership of the equipment covered in this order shall remain with the seller until equipment is paid for in full. It is further agreed by the
purchaser that the seller cannot be responsible for conditions resulting from existing facilities,changes in mineral content or color of water supply,outside
drainage, pump, sand,weather, or conditions beyond the seller's control. Purchaser shall be responsible for weather protection.
Date
Representative Purchaser
'rS �
yCash
City of Atlantic Beach • • •• '
DESCRIPTION • CITY PAID
PermitTRAK $66.00
PLRS19-0127 Address: 1732 ATLANTIC BEACH DR APN: 169505 1675 $66.00
PLUMBING $62.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 1 $7.00
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: R9480 $66.00
Date Paid: Monday,July 08, 2019
Paid By: AFFORDABLE WATER/KINDER INC
Cashier: CB
Pay Method: CREDIT CARD 2
Printed: Monday,July 08,2019 11:34 AM 1 of 1 of