356 10th St - Plumbing Permit CITY OF ATLANTIC BEACH
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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: PLRS17-0004
Description: install 17 fixtures
Estimated Value: 1000
Issue Date: 11/16/2017
Expiration Date: 5/15/2018
PROPERTY ADDRESS:
Address: 356 10TH ST
RE Number: 170043 0000
PROPERTY OWNER:
Name: EZELIUS PER OLOF
Address: 356 10TH ST
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: COUF PLUMBING LARRY COUF
Address: 1104 Wood Hill PL
JACKSONVILLE, FL 32256
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$7,500.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
L J Ph(904) 247-5826 Fax (904) 247-5845 PL�S 1l _ C00W
JOB ADDRESS: 3�; c C7 h �!Y�-� PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$ I GG G
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTS'
Bathtub I Septic Tank&Pit
Clothes Washer _� Shower 3
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 44
Hose Bibs t 1 Urinal
Kitchen Sink ( _. Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory S- Water Heater
1.
Other Fixtures Water Treating System
RE-PIPE: RECEIVED
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTS'
Bathtub Septic Tank&Pit
Clothes Washer Shower MAR — 5 -
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compart8b08,„}]�'ttJJ Department
Floor Sink Toilet
Hose Bibs Urinal City of Atlantic EFeia, FL
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.'
❑ Other
rk 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 wo
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
er state or local law regulation construction or the performance of construction.
or not. The permit does not give authority to violate the provisions of any oth
Property Owners Name (DICPhone Number
Plumbing Company G Flu Office Phone qbr( ��°�"33` ax
X14-3 3&(
Co. Address: ft U w°Ci��' j( �� City ��+ { State Zip
License Holder (Print): C-41o,''1/ State Certification/Registration# CFC '17 11 ` T 7
Notariz=' ,HolderHolder
SPERGER 20
N#FF 924951 Before me thiday ofober 6,2019
pPublic UrAerwrters
Signature of Notary Public
I�L
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i
Cash Register Receipt Receipt Number
City of Beach
R3476
DESCRIPTIONACCOUNT QTY PAID
PermitTRAK $179.22
PLRS17-0004 Address: 356 10TH ST APN: 170043 0000 $179.22
PLUMBING $174.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 17 $119.00
STATE SURCHARGES $5.22
STATE DBPR SURCHARGE 455-0000-208-0600 0 $2.61
STATE DCA SURCHARGE 455-0000-208-0700 0
TOTALPAID BY RECEIPT: • $179.22
Date Paid:Thursday, November 16, 2017
Paid By: COUF PLUMBING LARRY COUF
Cashier: LE
Pay Method: CREDIT CARD 8
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Printed:Thursday, November 16,2017 2:39 PM 1 of 1