77 Shell St plbg permit -i lyLy j-
Y. Jar
CITY OF ATLANTIC BEACH
ri 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job 10: 16-PLBG-2422
Job Type: PLUMBING ONLY
Description: install washer, lavatory, shower pan, toilet, water heater
Estimated Value:
Issue Date: 10/27/2016
Expiration Date: 4/25/2017
PROPERTY ADDRESS:
Address: 77 SHELL ST
RE Number: 169582-0000
PROPERTY OWNER:
Name: WHITE REV TST ET AL, ELIZABETH,
Address: 1510 EAST RD
GENERAL CONTRACTOR INFORMATION:
Name: WAYNE CONN PLUMBING INC.
,CFC1428564
Address: 6915 W BEAVER ST
Phone: -
FEES:
Plumbing Fixtures $35.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY W ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
PLUMBING PERMIT APPLICATION 23d f
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
`Ph(904) 247-5826/ Fax(904)247-5845
JOB ADDRESS: / 7 , ) �/f/ �— PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE oFFIXTURE QTY TYPE oFFixTORE 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 oFFixrukE 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:
D Sewer Replacement D Back Flow Preventer D Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
D Lawn Sprinkler System-Number of Heads D Well
**SJRWD Well Completion Form.Completed forth to be submitted to the Building Department for final inspection.**
D 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 we 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 m violate the provisions of y o or state or local law regulation construction or the performance of construction.
Property Owners Name �L/Z4���h Wl � Phone Number
Plumbing Company"{/.l� �.fl.Jflirt! Office Phone t�S.3",�/O,IFax
Co.Address:4io G� //P//�'R�r-S City/ State CZZips�4s—
License Holder(Print): v� S/D�249 State Certification/Registration
Notarized Signature of License Holder —�—
atEPluaE KW" Before me this day o 20
My C0kga9I0a BFF19%i2
*KSIf* EXPIRES:May 1s,2Btll Signature of Notary Publ' (I �A fhn �,o i
"q''R�'eii++dA' BekeOlnry BWANon75rrM
{-� 1 NOTICE OF COMMENCEMENT
State of r 1 O RI dA. Tax Folio No.
Countyof CILva1
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713 of
the Florida Statutes,the following information is stared in this NOTICE OF QpQp'd�MF�CEt�J�NT. f
Legal Description ofproperty being improved: 'L(n n�OR4�ry �tl0.n'{-iC IY�ea e� (.LN (
Address of property being improved: I�M five- flarI �� ZZ
General description ofprovements: LL t( Ul C1i-sk e
1/Catnrr -6 bi r - I
er: Kl Address: �KJ VOfI C 0.- KWS090
Owner's interest in site of the improvement: 1nfq.sk n q4ny1 V- a 000 q
Fee Simple Titleholder(if other than owner):
Name: gro- 1 VALIerS
Contractor: Tl
Address:�7'+aen's e � lac 6n n u� � e- FL 32205
Telephone No.:(904\1 SOq -4919 Fax No:
Surety(if any)
Address: Amount of Bond S
Telephone No: Fax No:
Name and address of any person making a loan for the construction of the improvements
Name:
Address:
Phone No: Faz 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)(6),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
Doc%2016246999.OR BK 17756 Page 269, Signed: Dene: / O
Number Pages:I Before m t�JLJI, day of E(' in Ne Co ty ofDuval,Stene
Recorded 1W2712016 at 09:27 AM, Of Florida,has personally appeared C. W aPR$
Ronnie Fussell CLERK CIRCUIT COURT DUVAL Notary Public atLarge,State of Florida,Caunly of Duval.
COUNTY my,uq �� s: ZD�
RECORDING$10.00 Personal) K�lZwa% r
ut oduceA Identification: ¢" I TSA A.HOLM
MyooMMIXB pN x
'a,�R a0 E�mrS:r®eM 2aP