647 Selva Lakes PLRS22-0052 Plumbing Permit N`' '`• PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS22-0052
• 800 SEMINOLE ROAD ISSUED: 4/5/2022
ATLANTIC BEACH. FL 32233 EXPIRES: 10/2/2022
INSPECTIONMUST CALL • 14FOR DAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITIONr OF • • • • BUILDING
CODE, AND CITY OF • • OF ORDINANCES .
ALL CONDITIONS or
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.
• • err • r • OF • •
647 SELVA LAKES CIR PLUMBING RESIDENTIAL PLUMBING - 15 FIXTURES $1500.00
ZONING:TYPE OF REALESTATE SUBDIVISION:BUILDING USE
CONSTRUCTION: NUMBER: GROUP:
172027 5900 SELVA LAKES UNIT 03
COMPANY: rr •
STYLES SMITH PLUMBING, JACKSONVILLE
INC 1537 PENMAN RD SUITE A BEACH FL 32250
• ADDRESS: CITY: STATE: ZIP:
TORRES JONATHAN 647 SELVA LAKES CIR 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.
LIST OF CONDITIONS
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 455-0000-322-10M 0 $55.00
PLUMBING FIXTURES 4SS-MW-3221000 15 $105.00
STATE DBPR SURCHARGE 455-MM-208-07M 0 $2.40
STATE DCA SURCHARGE 455-0000-2080600 0 $200
TOTAL:$164.40
Issued Date:4/5/2022 1 of 2
Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd,Atlantic Beach, Fl-32233
Phone: (9044)'247-5826 Email: Building-Dept@cclab.us PER IT#:
JOB ADDRESS: 4- 4/7 5e,VA L 4xe s5//Gir PROJECT VALUE
❑NEW OR REPLACEMENT INSTALLATION and/or & E-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub .1 Septic Tank& Pit
Clothes Washer Shower 1
Dishwasher 1 Shower Pan 2
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs :t Urinal
Kitchen Sink 1 Vacuum Breakers
Laundry Tray Water Connected Appliances_
Lavatory Water Heater 1
Other Fixtures Water Treating System
❑MISCELLANEOUS 1
❑Sewer Replacement /\
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler heads)
Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
r' Well "SIR,��vt�D Wel/Comp/eyon Form.Completed form to be submitted to the Building Department for final Inspection.•'
Other ?teDZC / M J�of n l<tic fib✓ fo G' Y i 6
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.
I 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.
Owner Name: � nn 4-1 Vt cin I O f'1`e S Phone Number:
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Plumbing Company: ��p 5 CIMi fit !l.N/�/� fficGe Phone: goy :Z 2//'y/�/ Fax
Co.Address: 1537 Ppil,.•rnr Id City: TNc BeA&a State:tCL. Zip: 3,2A.50
License Holder:l7ITr�Pi[l- 4",z/7 State Certification/Registration# /-A6 IYA W0g�
Notarized Signature of license Holder G
The foregoi rument was cknowledged before me thisada 2C;—?",the State of Florida,
County of O ai
Signature of Notary Public
MM
jPersonally Known OR [ ] Produced Identification
DLESPERGER Type Of Identification:
SIDNg GG 3u,377gDctabere,2023upaahaao/i7rya
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