1528 W Park Terr sewer replacement 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: PLRS1 8-0024
Description: sewer replacement
Estimated Value: 2000
Issue Date: 1/30/2018
Expiration Date: 7/29/2018
PROPERTY ADDRESS:
Address: 1528 W PARK TER
RE Number: 1719390000
PROPERTY OWNER:
Name: GHICTTO PHILIP M
Address: 1528 PARK TER W
ATLANTIC BEACH, FL 32233-5535
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: KIMBALL PLUMBING, INC.
Address: 836 Mamie Road QA 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
FINANCING9 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$7,500.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BE ACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904)247-5826 Fax(904)247-5845 f'EiMl �
JOB ADDRESS: VV —PERMIT
NEW OR REPLACEMENT YNSTALLATION: Project Value$
TYPE OF r'IXTURE QTY TYPE OF r'IX TUR E QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartinerit Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Applian S
Lavatoty
Water Heater
Other Fixtures Water Treating System
RE,-PIPE:
TYPE OF F,IXTUR E QTY TYPE. OF FixTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
floor Dmin Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Applian i
Lavatory Water Heater
Other Fixtures Water Treating System
,rSCELLANE,OUS: .
wer Replacement 0 Back Flow Preventer u Grease Interceptor(Trap) i illons(Requires 3 sets of plans)
Lawn Sprinkler System-Number of Heads 0 Well
**'SJRWD Well Complefion Form. Complete�F_form to be submitted to the Building De- i Iment for flnol inspection,**
o Other
Permit becomes void if iyork does not commence within n six month period or work-Is stispcndcd or abuidoned forms 7 "bs.I hereby oenif
y Iliat I ha=
this tipplictnion and know tbe.same to be truc&M contct. All provis�s of Jaws and ordinances governing Ws%voi+ v H be compfied with wtether spccl�lcd
or not. The permit does not give to violate the provisions of any other state or local la%v regulation construc i or the performance o f construction.
Property Owners Name.N`� Phor qumber W.P.
Plumbing Company V' VwOctm Office Pholl./14P
Fax V4
Co.Address:1?7!f0 City —State Zip o'
License Holder(Print): V= 4'1 YVVC( State Certificatiom4 e ,�stratiori R
Notarized Signature of License Holder�� L h_ JPY_19_,1,
B efo re m e I d a—y o f—, 20
J E""'I"OSKI
ENNIPIAXOSKI
-51� 1,
NotatyPjbiic SweofPorida Signature of Notary Public tt�
C? I. C
C 13, 8,
C011n1;5$:0'1-GC.13,689 t
Cash Register Receipt Receipt Number
City of Atlantic Beach R4087
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $66.00
PLRS18-0024 Address: 1528 W PARK TER APN: 171939 0000 $66.00
PLUMBING $62.00
455-0000-322-1000 0 $55.00
PLUMBING BASE FEE
PLUMBING FIXTURES 455-0000-322-1000 1 $7.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0600 0 $2.00
STATE DCA SURCHARGE 45500002080700 0 $2.00
TOTAL FEES PAID BY RECEIPT: R4087 $66.00
CITY OF ATLANTIC BEACH
800 SEMINOLE RD
ATLANTIC BEAC,FL 32233
01;3012018 14:47:44
CREDIT CARD
VISA SALE
Card XXXXW=1914
SEQ 8
Balxh 532
INVOICE 8
Approval Code: 02319C
Entry Method: Maul
Mode: Onihe
Card Code: M
SALE AMOUNT $661
CUSTOMER COPY
Date Paid:Tuesday, January 30, 2018
Paid By: KIMBALL PLUMBING, INC.
Cashier: BA
Pay Method: CREDIT CARD 8
ot
Printed:Tuesday,January 30,2018 2:48 PM I of I