603 Selva Lakes Cir plbg permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: PLRS17-0061
Description: re-pipe 14 fixtures
Estimated Value: 2000
Issue Date: 7/24/2017
Expiration Date: 1/20/2018
PROPERTY ADDRESS:
Address; 603 SELVA LAKES CIR
RE Number. 172027 5544
PROPERTY OWNER:
Name: WATTS ANN C
Address: 603 SELVA LAKES CIR
ATLANTIC BEACH, FL 32233-4378
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: KIMBALL PLUMBING, INC.
Address: 836 Mamie Road OA MARK EDWARD KIMBALL
Jacksonville, FL 32205
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$7,500.
iw
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
0 Ph(904)247-5826 Fa(904)247-5845
IDB AnDBt sg: ` () c ( &kt,�- •C I�nT
_PERu PoR 5l4-oo�i
NEW OR REPLACEMENT INSTALLATION: Project Value$,�000 _
TYPEOFFIXTURE QTv TYPEOFFIXTURE QTY
Bathtub Septic Tank&Pit ---
Clothes WasherShower —
Dishwasher Shower Pen
Drinking Fountain Slop Sink —
Floor Drain Three compartment Sled
Floor Sink _. Toilet —
Hose BibsUrinal —
Kitchen Sink Vacuum Breakers _--
Laundry Tray Water Connected Applin xs
T Water Heater
Lavatory _--
Other Fixtures Water Treating System
RE-PIPE:
TYPEOFFIXTURE QTY TYPEOFFIXTURE QTY
BeUltub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pen
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sin
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
LaundryTray Water Connected Applin ces
Lavatory Witter Hater
Other Fixtures Water Treating System
MISCELLANEOUS:
0 Sewer Replacement 0 Back Flow Preventer 0 0rease Interceptor(Trap)_ gallons(Requires 3 sets of plans)
0 Lawn Sprinkler System-Number of Heads 11 Well "* **
**'VRWD Well Completion Form.Completed form to be submitted to the Bmla6g D partment for final inspection.
❑Other
Permit bomes void if work does not woromm wdhin a six month period or work is suspended or abandoned fm Iz mamhs.l hereby cetylry that lave reed
e
Ibis application and know the same to be we and ronecr, All provisions orinvs and ordinanccs goveming this ws will be complied with whether specified
or not. The pemlit does not give aulhoairy to violate the provisions of my other sate or loeal law regulation conAs unit a the performance of wromiction.
Property Owners Name PAYlh wad' -) Phi a Number 33�'1.(00 ( b
Plumbing Conimmy_ 4Lt.s(1eC(t, l�IA.�V1l Office Phant hiI e �/ Fax7��'����35,
Co.Address: 3 OUB City 0. . �i f pl—zip�J
License Holder(Print): rrt.l G 111. St ate Certification registration#C;70$�-19—
Nolarized Si Ralnre ! Iden
JENNIFEa KOeIU
'Anne
ruollns"1 1"Florida Clore me this •r ` day of �� 20 -7
My comm,Espiras Omni. in.
"lC k?I tl ` onaaen In ougn na anal xoun nuo. Igneturc of Notary Public
�f' Y
Cash Register Receipt Receipt Number
City of Atlantic Beach • �
DESCRIPTION
$157.30
PermitTRAK
PLR517-0061 Address: 603 SELVA LAKES CIR APN: 172027 5544P $157.30
PLUMBING $153.00
PLUMBING BASE FEE 95`x0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0IX10.322-1000 14 $96'00
STATESURCRARGES $4.30
STATE DBPR SURCHARGE 455-0000-20&0600 0 $2.30
STATE DCA SURCHARGE 45500002080700 0 $2.00
TOTAL • F $157.3F
Date Paid: Monday,July 24, 2017
Paid By: KIMBALL PLUMBING, INC.
Cashier:CT
Pay Method: CREDIT CARD 07385C
Printed:Monday,July 24,2017 12:30 PM 1 of 1