1701 Selva Marina Dr 2013 kitchen bath remodel/window Application Number . . . . . 13-00002601 Date S/03/13
Property Address . . . . . . 1701 SELVA MARINA DR
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 23725
----------------------------------------------------------------------------
Application desc
KITCHEN BATH REMODEL
------------------------------------------------------------- --------
Owner Contractor
------------------------
------------------------
STER, JOHN W NORTH RIVER BUILDING SOLUTIONS
1701 SELVA MARINA DR. 6771 SHINDLER DR
ATLANTIC BEACH FL 322335617 JACKSONVILLE FL 32222
(904) 838-9179
Structure Information 000 000 KITCHEN AND BATH
Occupancy Type . . . . . . RESIDENTIAL
----------------------------------------------------------------------------
Permit . . . . . . RESIDENTIAL ALT/OTHER
Additional desc - - Plan Check Fee 85 . 00
Permit Fee . . . . 170 . 00 Valuation . . . . 23725
Issue Date . . . .
Expiration Date . . 10/30/13 --------------
-------------------------------------------------------------
Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 NATIONAl ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY. ---------------
-------------------------------------------------------------
other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 55
STATE DBPR SURCHARGE 2 . 55
---------- -----------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 170 . 00 170 . 00 . 00 . 00
Plan Check Total 85 . 00 85 . 00 . 00 . 00
Other Fee Total 5 . 10 5 . 10 . 00 . 00
Grand Total 260 . 10 260 . 10 . 00 . 00
BUILDING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Road, Atlantic Beach, FL 32233 MAP 2 2013
Office (904) 247-5826 Fax (904) 247-5845
Job Address: 1-70 &,*14, MoLr,AA_ bc, Permit Num
V"�M.4;
Legal Description 2),ft - 11 0 St I VOL Parcel# 4/k 110
. .0e Floor Area ot S S t
Valuation of Work$_,231Z�5 , _ProposedW led nq��nheated/cooled
Class of Work(circle one): New Addition ��teratio Repair Move Demolition pool/spa window/door
Use of existing/proposed structureQ)(circle one): Commercial
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed:-
Property Owner Information:
Name: !T4 La A S_-[C(t Address: 177n/ &dVa AunA&
City Aea State Zip
,2233—Phone
E-Mail Fax#(Optional) rn r rinDV ,
r ILL UVI I
Contractor Information:
Company Name: Qualify�ing PLgent: 14A- ywA
t- zip IZ22z-
Address: (rni SL;.j1e_ bf city
Office Phone 63oq 819-19L19 Job Site/Contact Numbe 2 9-!R 124 Fax#
State�Ceitification/Rep-istration#_CjGr_ 1'�.j Pig I A
Architect Name&Phone# nMVMVVTnD V01K CODE COMPLIANCE
Engineer's Name&Phone# 5 1FCITY OF XT1,ANnC REACH
L
Fee Simple Title Holder Name and Address SEE PERMUS FOR ADDMQN�C_
Bonding Company Name and Address REQUIREMEM AND COENDMONS.
Mortgage Lender Name and Address in
VArE., Z/
4pplication is hereby made to obtain a permit to do the work and installations ior to the
issuance ofa permit and that all work will be pqybrmed to meet the standards ofall laws regtil�iiinj�onstrucVon in thisill. pertlmecmes null
and void if work is not commenced within six(6)months, or if construction or work is suspended or abandonedfor a period mo?;ths at any time affte
work is commenced. I understand that separate permits must be securedfor Electrical-Work, Plumbing, S�gns Wells. 12flsix urnacesi� Boilers, Heaters,
Tanks and Air Conditioners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
I hereb�certify that I have read and examined this application and know the same to be true and correct. All provisions oflaws and ordinances governing this
ty to violate or cancel the
work will be complied with whether specified herein or not. The granting of a permit does not presume to give authori
provisions of any otherfederal,state, or local law regulating construction or the peiformance ofconstruction.
Signature of Owner Signature of Contracto
Print Name M to ................................
Print Name s4tr ... .... .... ...........
............. ..........V.4............................................................................
Sworn to and subscribed before me Sworn to and subscribed before me
�-'i__z�� 15a�o` A^_
t 5�- Day of this __L-Day of 20
Notary u i Notary Public
REGAN P KMKed 0).26.10
L 16r-
REGAN P HECK
W COMMISSION#EE201120
FkMF:-R Upm 22
MY COMMISSION#EE20 20ig
1120
City of Atlantic Beach
eno
Building Department
800 Seminole Road
Atlantic Beach, Florida 32233-5445
Phone(904)247-5826 - Fax(904)247-5845
-dept@coab.us =I M
E-mail: building
Cityweb-site: hftp://www.r-oab.u--,
APPLICATION REVIEW AND TRACKING. FORM
Property Address: M17TJ/7(k_ Dgpartment review required Y No
I (�_Wdind'�:> -7
Applicant: 0/)S Planning &Zoning
Tree Administrator
Project: Public Works
Public Utilities
Public Safety
FF—ire Services
Other Agency Review or Permit Required Review or Receipt Date
of Permit Verified By
Florida Dept. of Environmental Protection
Florida Dept. of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
Reviewing Department First Review: E�rApproved. F-]Denied.
(Circle one.) Comments:
=BUILDING�
PLANNING&ZONING Reviewed by: Date:
41
TREE ADMIN. Second Review: RApproved as revised. F�Denid
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review: FlApproved as revised. []Denied.
Comments:
Reviewed by: Date:
Revised 07127110
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
-5814
INSPECTION PHONE LINE 247
Application Number . . . . . 13-00002602 Date 5/03/13
Property Address . . . . . . 1701 SELVA MARINA DR
Application type description WINDOW AND/OR DOOR
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 23725
----------------------------------------------------------------------------
Application desc
WINDOW REPLACEMENT
-----------------------------------------------------
Owner Contractor
------------------------
NORTH RIVER BUILDING SOLUTIONS
STER, JOHN W 6771 SHINDLER DR
1701 SELVA MARINA DR. FL 32222
ATLANTIC BEACH FL 322335617 JACKSONVILLE
(904) 838-9179
----------------------------------------------------------------------------
Permit . . . . . . WINDOW AND/OR DOOR PERMIT
Additional desc . - 85 . 00
Permit Fee . . . . 170 . 00 Plan Check Fee
Issue Date . . . . Valuation . . . . 23725
Expiration Date . . 10/30/13 ---------------
-------------------------------------------------------------
Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 NATIONAl ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
WINDOW AND DOOR INSPECTION:
*INSTALLATION INSTUCTIONS REQUIRED
*ALL STICKERS ARE TO REMAIN ON THE WINDOWS
*PROVIDE ACCESS TO ALL WINDOWS TO INSPECT FASTENERS
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE DCA SURCHARGE 2 . 55
STATE DBPR SURCHARGE 2 . 55
- -------- -----------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 170 . 00 170 . 00 . 00 . 00
Plan Check Total 85 . 00 85 . 00 . 00 . 00
Other Fee Total 5 . 10 S . 10 . 00 . 00
Grand Total 260 . 10 260 . 10 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
BuILDING PERMIT APPLICATION 13 z U 0 *Z---
CITY OF ATLANTIC BEACH � HNUTM
FILE COPY 800 Seminole Road, Atlantic Beach, FL 32233 MA� 0 2 2013
i Office (904) 247-5826 Fax (904) 247-5845
F I
uj I,` I-y 2-
Job Address: 1-70 SejVek Marl'f% Permit N L14" a-A-- c
_4
Legal Description '�i\ - 2,q KII-C 10
Floor Arred of- S,q.F t 9q.Ft
Valuation of Work$ Proposed Work beated/cooled non-heated/cooled
Class of Work(circle one): New Addition &teratio�$ Repair Move Demolition pool/spa window/door
Use of existing/proposed structure(s) (circle one): Commercial 1;;�-
If an existing structure,is a fire sprinkler system installed? (Circle one): Yes <� N/A
Florida Product Approval#
For multiple products use product approval form
Describe in detail the type of work to be performed: geolakcL 14 jh(No Le!-%JQLAss L44 ow
nej L'Z.jQ"j,T
Property Owner Information:
Name: f:ro L6 ml A C-14f, Address: /72ni SIPIVA Aunz%
City__AI�A�c &aJ, State fLZip_1223,3--Phone
E-Mail or Fax#(Optional)
Contractor Information:
Company Name: yal RjWj &JjjA J[kAg�, -7.,c- Qualifyy�ing kgent:
—n I te City ^V111c St fL- Zip YZZ2:7—
Address: (P SL, bf
Office Phone 5oq 839-')IM Job Site/Contact Number 836-jt'7q Fax#
State Certification/Registration# C4�Sr_ 15,1 Ml A
Architect Name&Phone#—
Engineer's Name& Phone# - I i P.P-7 - Ad 183oS FL
Fee Simple Title Holder Name and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
Application is hereby made to obtain apermit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the
issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. This permit becomes null
ter
and void if work is not commenced within six(6)months, or if construction or work is suspended or abandonedfor a diod ofsixo)months at any time af
U,
work is commenced. I understand that separate permits must be securedfor Electrical—Work, Plumbing, Signs, h ells, Pools, urnaces,Boilers, Heaters,
Tanks and Air Conditioners,etc.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING CONSULT WITH
YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT.
f laws and ordinances governing this
I here �t does not presume to give authority to violate or cancel the
,lb certify that I have read and examined this application and know the same to be true and correct. Allprovisionso
work will be complied with whether specified herein or not. The granting of a permi
provisions of any otherfederal,state, or local law regulating construction or the performance of construction.
Signature of Owner Signature of Contractor4z:L�� —
I �
Print Name C7 ................................................ Print Name 'J.-Sqa..--ar..........ro�-9 0,rn...................................
..........Vq.............................
Sworn to and subscribed before me Sworn to and subscribed before me
" Day of 2 O�' 20 1�3
t 9- Day of this Day of
N ry Notary Public
otary u i
AKed 01-26.10
REGAN P W
REGAN P HECK i my COMMIOWN#EE201120'
MY COMMISSM 0 EE201120 EXPIRES May 2Z 206
EXPIRES May 2Z 2016 �d J
407)""153
P-.*
NOTICE OF COMMENCEMENT
State of flo �9c, Folio No.
County of D tASW FILE COPY it
To Whom It May Concern: [Abw - -J. i I property, and in accordance with Section 713 of
The undersigned hereby informs you that improveme—
the Florida Statutes,the following information is stated in this NOTICE OF COMMENCEMENT.
Legal Description of property being improved: S
I L 01- f 31an
Address of property being improved: AAo,-nv,k0-- A:A ,
General description of improvements: C�.Ij
sr j1--rS
Address: nOl SAva
Owner a
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: 10 ru,
Address: (6-7-n I C
Telephone No.: '(0q - Fax No: I Oq (De�3_,Z,,l qj
S�urety(if any)
Address: Doc#2013110016,OR BK 16352 Page 1627.
Telephone No: Fax No: Number Pages:1
Recorded 05iO2/2013 at 12:12 PM,
Name and address of any person making a loan for the construction of the Ronnie Fussell CLERK CIRCUIT COURT DUVAL
COUNTY
Name: RECORDING$10.00
Address:
Phone No: Fax No:
Name of person within the State of Florida, other than himself, designated by owner upon whom notices or other documents may be
served: Name:
Address:
Telephone No: Fax No:
In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.06(2)(b),Florida Statues. (Fill in at Owner's option)
Name:
Address:
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one (1) year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER Date:
Signed: 013 in the n o val State
C -Tb�re iqle thisu / ?I-- day of /vIC44 f-e!
P HE Flor ared
�a,has personally appe
00MMISSION#EMJW ublic at Large,State of Florida,Coun of Duval.
MY I
EXPOM WWY22,2Wcorn issionexpires: F-F 22 11 or
'Wersona y Known:
roduced Identification: 3-6
PAUL S. LI, P.E. 418305 FL
DESIGN & CONSULTING ENGINEER
9218 CYPRESS GREEN DR, STE. #10
JACKSONVILLE, FL 32256
PlvTax: (904) 737-6876/737-2385 Proi��c�t# �l -304c) i
T;S
12
12 (A
.........
CITY OF ATLANTIC BEACH BUILDING DEPARTMENT
WIND LOAD
BASED ON THE FLORIDA BUILDING CODE 2010 RESIDENTIAL,
FIG. R301.2(4), THIS SITE IS IN TH :�b MPH ZONE. PER ASCE 7-10,
METHOD 1, THE IMPORTANCE FACTOR IS THE RISK
CATEGORY IS 11, AND THE EXPOSURE CATEGORY FOR AN
ENCLOSED BUILDING.
ROOF ANGLE A = tan -I f
MEANROOFHT =
HEIGHT & EXPOSURE ADJUSTMENT COEFFICIENT
ww = �' 6 'x I ��D 'x 2-6 -(-->
ROOFLOAD FLOOR LOAD IV
L.L. -z-D P.S.F. L.L. P.S.F.
D.L.--j7 PS-F- D.L. P.S.F.
T.L. ?�7 P.S.F T-L- R.S. -
REWEWED FOR CODE CONWLIANCE
CITY OF ATLANTIC BEACH
SEEpERMnSFORADDMONAL
10 ILI
GAData\WlNW0RD\F0RMS�hTLANTlC BEACH FBC RESIDE"AL 2010.dm
�QUIREMENIS AND CONDMONS. FILE COPY
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� u 'Depa
11: (Tic be assigned by tHe`6"ildiHd`
Building Department
800 Seminole Road
Atlantic Beach, Florida 32233-5445 01—
Phone(904)247-5826 - Fax(904)247-5845 6
ed*
E-mail: building-dept@coab.us �6
Cityweb-site: hftp://www.coab.us
APPLICATION REVIEW AN TRACKING. FORM
Property Add res.: paparygent review requi Yes No
A p p I i c a nt: lywal Z/r�r Yzt 10,11v Planning&Zoning
Tree Administrator
Project: Public Works
Public Utilities
Public Safety
Fire Services
Other Agency Review or Permit Required Review or Date
of Permit V
Florida Dept.of Environmental Protection
Florida Dept, of Transportation
St.Johns River Water Management District
Army Corps of Engineers
Division of Hotels and Restaurants
Division of Alcoholic Beverages and Tobacco
Other:
APPLICATION STATUS
7 en'u's c'
t
an
6 and Tobacco
Reviewing Department First Review: [--IApproved. MDenied.
(Circle.one.) Comments: t4eo 5 e A 0 v-e- 'Pill cv�� 'a pyc_ 04
BUILDING F)l 40,-MO 1'1(),A t
PLANNING&ZONING Reviewed by: Date:
TREEADMIN. Second Review: DApproved as revised. FIDenied.
PUBLIC WORKS Comments:
PUBLIC UTILITIES
PUBLIC SAFETY Reviewed by: Date:
FIRE SERVICES Third Review, MApproved as revised. ElDenied.
Comments-
Reviewed by: Date:
Revised 07127110
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CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00002597 Date S/02/13
Property Address . . . . . . 1701 SELVA MARINA DR
Application type description ELECTRIC ONLY
Property zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
----------------------------------------------------------------------------
Application desc
OUTLET SWITCHES
----------------------------------------------------------------------------
Owner Contractor
------------------------
------------------------
STER, JOHN W ALDERMAN ELECTRIC LLC
1701 SELVA MARINA DR. 4622 ORTEGA FARMS CIR
ATLANTIC BEACH FL 32233S617 JACKSONVILLE FL 32210
(904) S91-1092
----------------------------------------------------------------------------
Permit . . . . . . ELECTRICAL PERMIT
Additional desc . .
Permit Fee . . . . 69 . 80 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 10/29/13
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE ELEC DCA SURCHARGE 2 . 00
STATE ELEC DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 69 . 80 69 . 80 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 73 . 80 73 . 80 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITV OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
ELECTRICAL PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd, Atlantic Beach, Fl, 32233
Ph(904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: I/ O 'n PERMIT#
I /C.-,'z
JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE
VALUE OF WORK S
NEW SERVICE F� Overhead F-1 Underground Underground up Pole
-Residential(Main) Service
�0-100 amps [110 1-I 50amps LJ 151-200amps I-amps #of Meters
-Commercial(Main)Service
El 151-200amps L amps F I CT Service amps
0-100 amps 1--.101-150amps
Conductor Type Size
Multi-Family(Main) Service
iO-100 amps P,10 1-I 50amps 11 151-200amps amps of Unit Meters
Temporary Pole amps
SERVICE UPGRADE 1.i-amps CT Service amps
NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.) ICT Service amps
J;100amps LA50amps �200amps amps
ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC.
Outlets/Switches: 0-30amps 3 1-1 00amps _101-200amps
Appliances: 0-30amps :=31-100amps -10 1-200amps
A/C Circuits: �0-60amps 61-I 00amps
Heat Circuits: # circuits @ kw
Number of Lighting Outlets, Including Fixtures:
OTHER ELECTRICAL PROJECTS -1 Transformers KVA �Motors hp
'SwimmingPool USign rI Smoke Detectors_Qty
FIRE ALARM SYSTEM (Requires 3 sets of plans) VALUE OF WORK S
Qty_volts/amps
REPAIRS/MISCELLANEOUS ',.-!Panel Change 1 �OH to UG
i Replace Burnt/Damaged Meter Can !Safety Inspection
Other:
rt
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months. I hereby ce ify that 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 NameVA �IM�4�9�p Phone Number
_WYIr
Electrical Company_j Office Phone Fax
city �74 State/-/�� zip&g's/'�)
Co. Address: 19oAl State Certification/Registration# Mgvl�'
License Holder(Print): ehW4 J7-
NotariZ hanatige Qf r iron cg i1al r
SHIRLEY L GRAHAM
20
my COMMISGION#DD 95B60 me this day o _3
EXPIRES:February 14,2014
Bonded Thru Notary Public Unde rs
e of Notary Public
-I - 0
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
Application Number . . . . . 13-00002601 Date 6/05/13
Property Address . . . . . . 1701 SELVA MARINA DR
Application type description RESIDENTIAL ALTERATION
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 23725
----------------------------------------------------------------------------
Application desc
KITCHEN BATH REMODEL
----------------------------------------------------------------------------
Owner Contractor
------------------------
------------------------
STER, JOHN W NORTH RIVER BUILDING SOLUTIONS
1701 SELVA MARINA DR. 6771 SHINDLER DR
ATLANTIC BEACH FL 322335617 JACKSONVILLE FL 32222
(904) 838-9179
--- Structure Information 000 000 KITCHEN AND BATH
Occupancy Type . . . . . . RESIDENTIAL
----------------------------------------------------------------------------
Permit . . . . . . PLUMBING PERMIT
Additional desc . .
Sub Contractor . . TDG PLUMBING
Permit Fee . . . . 76 . 00 Plan Check Fee . 00
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 12/02/13
----------------------------------------------------------------------------
Special Notes and Comments
2010 FLORIDA BUILDING CODE, 2008 NATIONAl ELECTRIC CODE
*REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING
DEPARTMENT IMMEDIATELY.
----------------------------------------------------------------------------
Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00
STATE PLBG DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 76 . 00 76 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 80 . 00 80 . 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 13 _26,'V
JoBADDRESS: 1 �2o / q oei;v�a- _2:1� I -PERMIT#
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
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:
[-i Sewer Replacement Ei Back Flow Preventer o Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
Li Lawn Sprinkler System-Number of Heads D Well
** SJR WD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.
Ei 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.
Property Owners Name SJ Phone Number
OfficePhone Fax-V4W
Plumbing Company L%
Co. Address: LA'-I D Lo C) a City's'-r State.FL zip
License Holder(Print):,--E- ? '� ' A�e State Certification/Registration I q:)- "20412
, _ �Z, ,J. &
Notarized Sig
URAHM
MYCOMMISSON# his d�ay 20
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EXPIRES:Februwary 14,2014
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