42 11TH ST WATER SOFT 2017 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
,:,Olswp INSPECTION PHONE LINE 247-5814
PLUMBING RESIDENTIAL —
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: PLRS17-0018
Description: WATER TREATMENT SYSTEM
Estimated Value: 0
Issue Date: 5/30/2017
Expiration Date: 11/26/2017
PROPERTY ADDRESS:
Address: 4211TH ST
RE Number: 170269 0000
PROPERTY OWNER:
Name: BELLES GREGORY R
Address: 24512 MOSS CREEK LN
PONTE VEDRA BEACH, FL 32082
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: AFFORDABLE WATERIKINDER INC
Address: 3760 KORI RD SPECIALTY WATER(CONS TDS QB)
JACKSONVILLE, FL 32257
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
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 RECORDING YOUR NOTICE OF COMMENCEMENT.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500.For HVAC work,a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233 ��^^ Q
Ph (904)247-5826 Fax (904)247-5845 P`R S l � —W I O
JOB ADDRESS: y Z TN STREET" A-fJ_4,tJnC BCH, FL _PERMIT#
3'2233
NEW OR REPLACEMENT INSTALLATION: Project Value S Co b• 00 ,
TYPEOFFIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor DrainThree Compartment Sink
Floor Sink _. Toilet
Hose Bibs - Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
LavatoryWater Heater
Water Treating System
- Other Fixtures
RE-PIPE:
TYPEOFFIXTURE 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 SinkToilet —
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 a Grease Interceptor(Trap)_gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads
❑ Well **
**SlRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ Other
.4 it becomes void if work does not commence within a six month period or work is suspended o band d f months.I hereby certify that I h as
fps application and know the same m be true and coma. 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 pe 32 ce Of construction.
GREG F3CXIle's Phone Number g05-7273
Property Owners Name 9V 4
Plumbing Company AFFOKI>ABLe. WA }EK Office Phone a/y-nr91 Fa�O
Co. Address: Zrk.o KO{' i ROad City TAcksari6 is State L„Zip OaZ5r
License Holder(Print): MARK fl • K)N D E — Stat C ification/Registmtion# 000 8l 8 e
Notarized Signature oft e Holder i /-'e/ (-y)q y 20 l 7
Sworn and subscribed be me this 2 5 day of
aP Notary Pudk sate or Fk
! DOMM M.Devine Signature of Notary P tic
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