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1941 (1943) Beach Ave bath kitchen remodel sliding door 2014 CITY OF ATLANTIC BEACH N J 800 SEMINOLE ROAD s) ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 14-00000118 Date 1/31/14 Property Address . . . . . . 1941 BEACH AVE Tenant nbr, name . . . . . . UNIT 1943 Application type description RESIDENTIAL ALTERATION Property Zoning . . . . . . . RES GEN MF DISTRICT Application valuation . . . . 43000 ------------------------------------------ Application desc REMODEL KITCHEN AND BATHS ---------------------------------------- Owner Contractor - ------------------------ ----------------------- DREW, WILLIAM CARK HORN BUILDERS INC 1632 S BAYSHORE DR 12 HOPSON RD MIAMI FL 33133 JACKSONVILLE BEACH FL 32250 (904) 673-4860 --- Structure Information 000 000 REMODEL KITCHEN BATH Occupancy Type . . . . . . RESIDENTIAL ---------------------------------------- Permit . . . . . . RESIDENTIAL ALT/OTHER Additional desc . . Permit Fee . . . . 265 . 00 Plan Check Fee 132 . 50 Issue Date . . . . Valuation . . . . 43000 Expiration Date . . 7/30/14 ---------------------------------------------------- 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 3 . 98 STATE DBPR SURCHARGE 3 . 98 Fee summary Charged Paid Credited Due ---------- --------- ---------- - Permit Fee Total 265 . 00 265 . 00 . 00 . 00 Plan Check Total 132 . 50 132 . 50 . 00 . 00 Other Fee Total 7 . 96 7 . 96 . 00 . 00 Grand Total 405 .46 405 .46 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. �., ri -� ILDING PERMIT APPLICATION & v L� k CITY OF ATLANTIC BEACH JAN 2 7 FILECOP18 91 Seminole Road,Atlantic Beach,FL 32233 �Office (904) 247-5826 Fax(904)247-5845 lRy Job Address: r-L- Permit Number: — Legal Description Lv 1 5-3' /. 4-12-*A+ r-�-L 91c-1wef jr�, ackwc- 15�Parcel# oor Area o q. t. s� q. t Valuation of Work$ Proposed Work heated/cooled non-heated/cooled 3,1046 Class of Work(circle one): New Addition Alteration Repair Move Demolition pool/spa window/door Use of existing/proposed structure(s)(circle one):. Commercial �Residen 'If an existing structure,is a fire sprinkler system installed? (Circle one N /A Florida Product Approval# For multiple products use product approval form Describe in detail the type of work to be performed: �N­OP%`E fit ) /i el� P pt—Ditg_ &A t N 4' 57-re-t4cru&-,4 L_ L,� K Property Owner Information: / Name: Address: 1(o3-2- See Tk 3-4YSrr-z& vc- oZ City 0_6 CtD Nt.1, G,IZ6✓f State��Zip 33f 3 3 Phone 26 — 7 S3 -�,�Z SS E-Mail or Fax#(Optional) Contractor Information: Company Name: Qualifying Agent: CN)ge- E S v.2 N Address: 1/33 S owa� D-a 645 Ci �,c rst•�Vs2-C C-' State C Zip 3 Office Phone690y0 2 2 - 7_l ab Job Site/Contact Number goy)( .z.3 3 - 51M o 9p4)I State Certification/Registration# C 6 C 0-5$9'0 z Architect Name&Phone# ,-j Engineer's Name&Phone# Fee Simple Title Holder Name and Address .� Bonding Company Name and Address "64 Mortgage Lender Name and Address I a/,. Application is hereby made to obtain a permit to do the work and installations as indicated I certify that rzo work or installation has commenced prior et o the issuance of a permit and that all work will be performed to meet the standards of all laws rpegulating construction in thpis jurisdiction. TJzis permit becomes null work isdmzmenced.of I understandNthatzseparate per s must be secured for Electrics!Workd Plums ng�Slgns,aWel(soPoo(sxuTnaczes, Boile stziYeaiersr Tanks and Air Conditioners,eta 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 hereby certify that I have read and examined this application and know the sante to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other federal,state, or local law regulating construction or the performance of construction. Si nature of Owner Signature of Contractor g tJ W-/l,-w»r stir r� t`tyr .�,4� .. Print Name Print Name Sworn to and subscribed before me Sworn to and subscribed before me 20 this 27 Day of "S"PrNµAa 20 Y this z-7 Day of Notary Pu lie ' Notary Public PATRICK RICH , �!:.,�� PATRICK RICH rOMMISSIO,,N_`#wIFF VA75 # MY COMMISSION#FF 05 Revised 01.26.10 * '!S.Septembe 15,207 �� EXPIRES:September 15,2011 s rt.er�� eaNwkuIOU soot Notary Senices �'+rf�,ye`° BorbedTMuBudpetNaluyS4niW Doc # 2014023913, OR BK 16677 Page 94 , Number Pages: 1, Recorded 01/31/2014 at 12:23 PM, Ronnie Fussell CLERK CIRCUIT COURT DUVAL COUNTY RECORDING $10.00 NOTICE OF COMMENCEMENT Permit No. Tax Folio No. Jq State of Florida,County of Duval THE UNDERSIGNED hereby give notice that the improvement will be made to certain real property in accordance with Chapter 713,Florida Statutes,the following information is provided in this Notice of Commencement. 40 L Description of property(legal description of property and address if available): LG S5 /� ATG r4rsTis iz t 7#� G/r�r T Ad r 2. General Description of improvements: a ;�e-�J CA- i�.,-TTrt 61 �L�UrH C li ���E ~ 'n ayL1�, rCrtEN o 1Gc 3. Owner Information: T �.,yu✓�f=e a)Name and Address: (Z Ltr�oln-r �2�'^r /G 3` �c+u rrt 8t;YS"ree J Z- b)Interest in property: 33 i"3 3 c)Name and address of simples titleholder(if other than owner): r � A 4. Contractor Information: twC.Su.i iIY Lt.r- �4 `, \ a)Name and Address: 3 A 3 5->zytn'a rc� �/L )Phone Number: z 5. Surety Information: a)Name and Address: N ZA b)Phone Number: C)Amount of Bond:$ 6. Lender Information: or a)Name and Address: b)Phone Number: ' 7. Person within the State of Florida designated by owner upon whom notices or other documents may be served as provided by 713.13(1)(a)7,Florida Statutes: a)Name and Address: 4.4 b)Phone Numbers of Designated Person: 8. In addition to himself/herself,Owner designates of to receive h; a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes. r r:= a)Name and Address: b)Phone Number of person or entity designated by owner: t 9 Expiration date of Notice of Commencement(The expiration date is one(1)year from the date of Recording unless a '6 different date is specified: " WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713,PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR g 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 COMMENCING WORK OR RECORDING �z YOUR NOTICE OF COMMENCEMENT. ra The foregoing instrument was acknowledged before me this 27 day of '3-nrL%A c-1 20� g g NOTARY PUBLIC,STATE OF FLORIDA ��►*;; PATRId(RICH MY COt�+IiSSION t FF 054075 Print Name: t+? ` EXPIRES:Sooembx 15,2017 YPersonally Known 10""', � o Boded ThruBWONdWYSenkq U Identification/Type: Verification pursuant to Section 92.525,Florida Statutes.Under penalties of perjury,I declare that I have read the . foregoing and that the fact stated in it are true to the best of my knowledge and belief. Signature of Property Owner Revised 10/1/2009 *VP :' +wF!'riF� if"kt'B."'moi,," +'C :;::.;t « �5:leaaa:'+mat. .ti"..:3ar�.S... is'1,.<iKM,*�?z�>-r.^'; City of Atlantic Bean-h APPLICATION NUMBER S Building Department (To be assigned by th Building Depa ent.) 800 Seminole Road �— Q �, c� Atlantic Beach, Florida 32233-5445 Phone(904)247-5826 • Fax(904)247-5845 / 7 E-mail: building-dept@coab.us Date routed: City web-site: hUp://www.coab.us APPLICATION REVIEW AND TRACKI G FORM kfi l9 3 Property Address: r ent review required Ye No Buildin Applicant: 4�z-7) &tanning Zoning Tree Administrator Project: dZZ 6 7-'Z/- Public Works Public Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review or Permit Required Review or Receipt Date of Permit Verified B Florida Dept.of Environmr I Protection Florida Dept.of Transport St.Johns River Water Ma :ment District Army Corps of Engineers Division of Hotels and Re, giants Division of Alcoholic Beve is and Tobacco Other: APPLICATION STATUS Reviewing Department First Revievq. Approved. []Denied. (Circle one.) Comments: YV O L BUILDIN PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: ❑Approved as revised. ❑Denied. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Revie QApproved as revised. ❑Denied. Comments: Reviewed by: Date: Revised 05/14/09 CITY OF ATLANTIC BEACH \ ii1 J 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 Application Number . . . . . 14-00000117 Date 1/31/14 Property Address . . . . . . 1941 BEACH AVE Tenant nbr, name . . . . . . UNIT 1943 Application type description WINDOW AND/OR DOOR Property Zoning . . . . . . . RES GEN MF DISTRICT Application valuation . . . . 2000 -------------------------------------- Application desc SLIDING DOOR ------------------------------------- Owner Contractor ----------------- ------------------------ DREW, WILLIAM CARK HORN BUILDERS INC 1632 S BAYSHORE DR 12 HOPSON RD MIAMI FL 33133 JACKSONVILLE BEACH FL 32250 (904) 673-4860 ----------------- Permit . . . . . . WINDOW AND/OR DOOR PERMIT Additional desc . 30 . 00 Permit Fee 60 . 00 Plan Check Fee 2000 Issue Date Valuation Expiration Date . . 7/30/14 ------------------------------------ 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 -- --------------------------------- STATE DCA SURCHARGE 2 Other Fees 2 . 00 STATE DBPR SURCHARGE Fee summary Charged Paid Credited Due - . 00---------- ---------- Permit Fee Total 60 . 00 60 . 00 00 . 00 Plan Check Total 30 . 00 30 . 00 00 . 00 Other Fee Total 4 . 00 4 . 00 Grand Total 94 . 00 94 . 00 . 00 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. F-, 1LDING PERMIT APPLICATION F CITY OF ATLANTIC BEACH JAN 27 1 L, E C 01 k,%'800 Seminole Road;Atlantic Beach, FL 32233 Office (904) 247-5826 Fax(904)247-5845RV 3L.z-33 r--L--Permit Number: / ' l 17 Job Address: %�'IG/3 ��/a �"`�, ��'� y Legal DescriptionLv moo a oAcrt q t"r5q t Proposed Work heated/cooled non-heated/cooled Pro Valuation of Work$��� P x000 . �d Class of Work(circle one): New Addition =AlterationRepair Move Demolition pool/spa window/door Use of existing/proposed structure(s)(circle one): Commercial Residen N /A If an existing structure,is a fire s Lir system . stalled. (Circle one : es Florida Product Approval# For multiple products use product approval orm JL/r-8p'n Describe in detail the type of work to be performed:_ Property Owner Information: Name: Address: 1�3z 5�...�Ti-c /jt►YSrl�2� j�Y-'vtr �' oz CityCe,Lr�—,- 4:;a-6"'f Stateri-Zip 33i l3 E-Mail or Fax#(Optional) Contractor Information: Company Name: yr>a.N ��C�z�c '_' Z^ Qualifying Agent: CN rq e.t�S ri c�Z N -�✓sic t States Zip Address: 1/33 5��'':•� ut D z. +_g- Ci .�€�c�cs�' Office Phone�ga`t) �Y z - Zl�� _ v Fax#/4jo�F ZqZ— zwo Job Site/Contact Number %o,I,�. 7 3 YgL ( State Certification/Registration Architect Name&Phone# 1 k Engineer's Name&Phone# Fee Simple Title Holder Name and Address •� Bonding Company Name and Address_ - Mortgage Lender Name and Address _ '' n work or llation has mmenced rior Applicaioon is hereby rm t ant d that al work wzll betperfad�:ed tothe omee therk and L standards of all tions as indicated. aws regulating construction in this juaisdiction. This pernLit beconsesontul issuancef p and void if work is not commenced within six e r:cmed or e construction or work is suspended or abandoned for a ertod of six 16)months at any time ate work is commenced I understand that separate permits must be secured for Electrical Work,Plumbing,Signs, Wells, Pools, t urnaces, Boilers,Fleaters Tanks and Air Conditioners,etc WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR OBTAIN FINWANCING, CONSULT WITH E FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. 1 hereby certify that I have read and examined this ap piication and know the same to be true and correct. All provisions give autho d ordinances toviiolategor cancel thi th type of work will be complied with whether sppecified herein or not. The granting of a permit does not presume to d h' provisions of any other federal,state, or local Inv regulating construction or the perfornuince of construction. Signature of Owner Signature of Contractor p� Print Name �:/t�AP- ice / ...... �r. Print Name -.................. ...._......................................................................... ........................... Sworn to and subscribed before me Sworn to and subscribed before me 20 fir, this 2.-7 Day of ,=rJ20 this z? Day of ' Notary Nota blic�o„rp� PATRICK RICH ,�Nrn r�4 PATMARai f°: OMMISSION 'P' # MY COMMISSION#FF I 054075Revised 01.26.10 Iv r. I FF 054075 * ='-S:September 15,2017 EXPIRES:September 15,2017 • al'rE�Rke�\ 6'(,Aq f hru Budget Notary Serv'axe �r''re.,�aoa��! Bonded Thru Budget Notery SMIM City of Atlantic Be;.!;--i APPLICATION NUMBER f� Building Departme,." (To be assigned by the Building Department.) 800 Seminole Road �� Atlantic Beach, Florida 22:%:33-5445 Phone(904)247-5826 • ax(904)247-5845 ' Oil E-mail: building-dept@c. b.us Date routed: City web-site: hftp://www.coab.us APPLICATION REVIEW AND TRACKING FORM Property Address: 1�1_Atcg 6 Department review required Yes No Applicant: Ate 77r/o���s fanning &Zoning Tree Administrator Project: Public Works Public Utilities Public Safety Fire Services Review fee $ Dept Signature Other Agency Review c;r Permit Required Review or Receipt Date of Permit Verified B Florida Dept.of Environmental Protection Florida Dept. of Transportation St.Johns River Water Management District Army Corps of Engineers Division of Hotels and Res" rants Division of Alcoholic Beve and Tobacco Other: APPLICATION STATUS Reviewing Department First ReviewApproved. ❑Denied. (Circle one.) Comments: BUILDIN PLANNING &ZONING Reviewed by: Date: TREE ADMIN. Second Review: ❑Approved as revised. ❑De Wed. PUBLIC WORKS Comments: PUBLIC UTILITIES PUBLIC SAFETY Reviewed by: Date: FIRE SERVICES Third Revie ❑Approved as revised. ❑Denied. Comments- Reviewed by: Date: Revised 05/14/09 CITY OF ATLANTIC BEACH J 800 SEMINOLE ROAD rl ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 J3 14-00000118 Date 2/04/14 Application Number . . Property Address . . • ' ' UNIT 1941 BEACH AVE Tenant nbr, name . . . . . 1943 Application type description RESIDENTIAL ALTERATION Property Zoning . . . . . . . RES GEN MF DISTRICT Application valuation 43000 ------------------------------- Application desc REMODEL KITCHEN AND BATHS ----------------------- -- -------------------------------------------------- Owner Contractor _ _ ------------------------ DREW, WILLIAM CARL ET AL HORN BUILDERS INC 1632 S BAYSHORE DR 12 HOPSON RD MALLOY, JENNIE S T/C JACKSONVILLE BEACH FL 32250 MIAMI FL 33133 (904) 673-4860 Structure Information 000 000 REMODEL KITCHEN BATH Occupancy Type RESIDENTIAL ----- ---------- Permit . ELECTRICAL PERMIT Additional desc Sub Contractor AMERICAN ELECTRICAL CONTRACTOR . 00 Permit Fee 90 . 00 Plan Check Fee 0 Issue Date Valuation Expiration Date . . 8/03/14 -------------------------------- ---------- --------------------------------- Special Notes and Comments 2010*REPORT OANY UNFORSEEN STRUCTURAL DAAMpAGEATOETHE TRIC O BUILDING DEPARTMENT IMMEDIATELY. 2 . 00 Other Fees _ STATE ELEC DCA SURCHARGE STATE ELEC-DBPR-SURCHARGE --------------- Paid Credited Due Fee summary Charged _ . 00------- Permit Fee Total 90 . 00 90 . 00 . 00 . 00 Plan Check Total 00 . 00 . 00 4 . 00 . 00 . 00 Other Fee Total 4 . 00 00 . 00 Grand Total 94 . 00 94 . 00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. ELECTRICAL PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd, Atlantic Beach, FL 32233 ( I Ph (90�G'(.r-\(AU 247-5826 Fax (904) 247-5845 n, . ADDRESS: VI`1 ( �" PERMIT# JEA INFORMATION REQUIRED ON ALL PERMITS AMPS VOLTS PHASE VALUE OF WORK$ NEW SERVICE ❑ Overhead ❑ Underground ❑1 Underground up Pole Residential(Main) Service 0-100 amps 101-150amps '1151-200amps amps #of Meters Commercial(Main) Service 0-100 amps 101-150amps 1151-200amps amps CT Service amps Conductor Type Size Multi-Family(Main) Service 0-100 amps 101-150amps 1151-200amps amps #of Unit Meters Temporary Pole 1 amps SERVICE UPGRADE amps CT Service amps NEW FEEDER(ADDITIONS,ACCESSORY STRUCTURES,ETC.) 100 amps 71150amps 200amps amps 1 CT Service amps ADDITIONS,REMODELS,REPAIRS,BUILD-OUTS,ACCESSORY STRUCTURES,ETC. Outlets/Switches: 0-30amps 31-100amps 101-200amps Appliances: 0-30amps 31-100amps 101-200amps . A/C Circuits: 0-60amps 61-100amps Heat Circuits: # circuits @ kw Number of Lighting Outlets, Including Fixtures: OTHER ELECTRICAL PROJECTS Swimming Pool , Sign (Smoke Detectors_Qty Ll Transformers KVA Motors hp FIRE ALARM SYSTEM (Requires 3 sets of plans) Qty volts/amps VALUE OF WORK$ REPAIRS/MISCELLANEOUS Replace Burnt/Damaged Meter Can ❑Safety Inspection i �P]anel Change OH to UG Other: KII I � Q Tip t-0 Y'\ Q.,m 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. I I Property Owners Name Q t`6 �(! ti ` Phone Number Electrical Company e--' �oy��r��tI"� 11bffice Phone "16"(-ri 7-r0 7c Fax Co. Address: S- ��� X15 D Cit State F( Zip L' -,e Holder (Print): EGr I �f Ce ification/Registration# N r' !derma �,► ►w Notary Public State of Florida Sworn and subscribed befor me this O 20 �p Anna M Daly aad'` Expires 01!25!2017 le My Commission EE 850790 Signature of Notary Public CITY OF ATLANTIC BEACH 1 800 SEMINOLE ROAD J ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 JF31�• Application Number . . . . . 14-00000118 Date 2/04/14 Property Address . . . . . . 1941 BEACH AVE Tenant nbr, name . . . . . . UNIT 1943 Application type description RESIDENTIAL ALTERATION Property Zoning . . . . . . . RES GEN MF DISTRICT Application valuation . . . . 43000 --------------------------------- Application desc REMODEL KITCHEN AND BATHS -------------------------------- Owner Contractor -------------- ---------- DREW, WILLIAM CARL ET AL HORN BUILDERS INC 1632 S BAYSHORE DR 12 HOPSON RD MALLOY, JENNIE S T/C JACKSONVILLE BEACH FL 32250 MIAMI FL 33133 (904) 673-4860 Structure Information 000 000 REMODEL KITCHEN BATH Occupancy Type . _ RESIDENTIAL -------------------------------- Permit . . . . . . PLUMBING PERMIT Additional desc . - Sub Contractor TURNER PLUMBING CO. Plan Check Fee 00 Permit Fee . . . . 104 . 00 0 Issue Date Valuation Expiration Date . . 8/03/14 -------------------------------- Special Notes and Comments 2010 FLORIDA BUILDING CODE, 2008 NATIONAL ELECTRIC CODE *REPORT ANY UNFORSEEN STRUCTURAL DAMAGE TO THE BUILDING DEPARTMENT IMMEDIATELY. -- 2 . 00--------------------------------- Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE STATE PLBG DBPR SURCHARGE 2 . 00 _ ________ ----- Fee summary Charged Paid Credited Due _ _ ---------- ---------- ------ -- Permit Fee Total 104 . 00 104 . 0000 00 . 00 00 . 00 Plan Check Total • 00 . 00 Other Fee Total 4 . 00 4 . 00 . 00 Grand Total 108 . 00 108 . 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 Jos ADDRESS: 5'e-raC_L'�_ 6 0L . ,� ��+- c 014 3 PERMrr# NEW OR REPLACEMENT INSTALLATION: Project Value$ TYPE of FIXTURE QTY TYPE of FIXTURE QTY Bathtub Septic Tank&Pit Clothes Washer Shower Dishwasher I Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet Hose Bibs Urinal Kitchen Sink t Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory Z 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: gallons(Requires 3 sets of plans) ❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) ❑ Lawn Sprinkler System-Number of Heads ❑ Well ** SIRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.** ❑ Other is suspended or abandoned for six months.I hereby certify that I have read Permit becomes void if work does not commence within a six month period or work 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 �' �'�"`` ° �— Phone Number Plumbing Company I �''^L'� `'` �' " r Office Phone 31J` � Fax 31('_-734�0 c1 3 Int .t"I L s � City h`ILS t,3111E State F( zip 3 22 Co. Address: _ � State Certification/Registration# L I`�-- 0 7-`��`�"� License Holder(Print): �--' ✓rte 3 I '"v- 11\ - Notarized Signature of License Holder a e this da 20J--- Notary Public State of F oda Shirley L Graham 1gna a of Notary Publ' �` My Commission FF 086990 a Expi—02/14!2018 r_l /o 7 � �