Permit Plbg 1840 Selva Grande Dr 2011 ',.: `, CITY OF ATLANTIC BEACH
'; "" ;x 3 .s 800 SEMINOLE ROAD
j ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
''''
Application Number . . . 11- 00002349 Date 7/15/11
Property Address 1840 SELVA GRANDE DR
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
1 fixture
Owner Contractor
HUCHAN, KELVIN AFFORDABLE WATER /KINDER INC
1840 SELVA GRANDE DR. 3760 KORI ROAD
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32257
(904) 262 -0197
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 62.00 Plan Check Fee .00
Issue Date Valuation 0
Expiration Date . . 1/11/12
Other Fees STATE PLBG DCA SURCHARGE 2.00
STATE PLBG DBPR SURCHARGE 2.00
Fee summary Charged Paid Credited Due
Permit Fee Total 62.00 62.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.00 4.00 .00 .00
Grand Total 66.00 66.00 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247 -5826 Fax (904) 247 -5845
JOB ADDRESS: 18 CIO S2i VA Grande_ DRS GC PERMIT #
, +Lanfic Beach, FL. 32233
NEW OR REPLACEMENT INSTALLATION: Project Value $
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 1
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 **
** SIRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection. **
❑ Other
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.
We.. l V in Le l d /helm Phone Number c�ay' 24 "775 2
Property Owners Name q�N
Plumbing Company A,� orcIal2 \AO fer Office Phon (o L-a1 `t - 7 Fax zoo - 4 ,2 9 L
Co. Address: 3r76O KORi Road City 3ackSonu ► I le State EL Zip '? 2:251
License Holder (Print): tAArLK • I-A t;o t: T .. State Certification/Registration # W - 3 21.1
Notarized Signature of License Holder 114•4-?r----:,---
Sworn and subscribed befo me this 1 A day •
• U4 t 20 1
a Notary Public State of Florida -
t
�p . Dorothy M Devore '
•
My Commission DD840269 Signature of Notary Pub is .m
‘orfe Expires 02/09/2013 .