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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 REVffiVW!=W 1 BY. 110'po? DAM 4-- �45 Y, (Z:.0 Nt a. o L't.-) -LLA-* CA ��6.0 ol -- ----------------- A A, .-777- _-A JA_ rb E D City of Atlantic Beach PPL1CAt!""­"�`UMB.`', � 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 Will C= So 00 Lj6j Immum"I" 11 Ln L" 0 OA —M lo, 50- ..On :tt 4h 0 w --r (2 0 0. cd (Or% cu I�j un IS -C:, U 0 0 r N Q Ld 0 .20 -02 Cd ;3 4 04 0 P� . td & cn 0 cd 06- 1-0 C-.4 0 0 kn cn . o cd 'n 0 0 0;.1 c) , V) F t� 0 p o 0 Id -8 Cd Q 0 10, 0- W 0 > bD m o Ln .2 0 cd r.: Cl -0 P64 2 CIS L.Lj :3 En -C) t� C) 4-4 > 0 Ln 0 Cd Ln C) U CA to It -15 41 > CIA > 0 cli = > -5 C) r— %) 0 U. u —..0 $.. Ln j%4 4r cl cls -2 75, u C) C�3 os M4 C) ol 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 "Neoe t EXPIRES:Februwary 14,2014 90mn(d8WdThruNotaiyPub!ik!�derw�ot ----, of Notary Publi