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1769 ATLANTIC BEACH DR - PLUMBING �S r lir: ' \ ss CITY OF ATLANTIC BEACH ? 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 051 9 INSPECTION PHONE LINE 247-5814 PLUMBING RESIDENTIAL - MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: PLRS18-0062 Description: PLUMBING 30 FIXTURES Estimated Value: 0 Issue Date: 3/12/2018 Expiration Date: 9/8/2018 PROPERTY ADDRESS: Address: 1769 ATLANTIC BEACH DR RE Number: 169505 1475 PROPERTY OWNER: Name: ADCOCK BRIAN J Address: 14560 ISLAND DR JACKSONVILLE, FL 32250 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: B & G PLUMBING, HEATING &AIR CONDITIONI Address: 2232 CORPORATE SQUARE BLVD 2232 CORPORATE SQUARE BLVD JACKSONVILLE, FL 32216 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. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. * 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$7,500. PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph(904) 247-5826 Fax(904) 247-5845 P(r R S--- V l TOB ADDRESS: 11 L q CA-1l...LLA'tci 13eACS. 0 ,,I,A. PERMIT# _ NEW OR REPLACEMENT INSTALLATION: Project Value$ TYPE OF FA'TURE OTY TYPE OF FIXTURE QTY Bathtub 1 Septic:Tank&Pit Clothes Washer ]- Shown' -2- Dishwasher / Shower Pan 1-- Drinking 'Drinking Fountain Slop sink Floor Drain t Three Compartment Sink __._ Floor Sink -- Toilet Hose Bibs 3 Urinal Kitchen Sink / Vacuum Breakers 3 Laundry Tray - Water Connected Appliances 1 LavatoryWater Heater Other Fixtures /. Wate Treating System RE-PIPE: TYPE OF FIXTURE OTY YPE OF FIXTURE OTY Bathtub Septi,Tank&Pit Clothes Washer Shower Dishwasher Shower Pan -- Drinking Fountain Slop Sink Floor DrainThree Compartment Sink Floor Sink Toilet Hose BibsUnn`.l Kitchen Sink Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory • Water Heater Other Fixtures Water Treating System MISCELLANEOUS: (Requires 3 sets of plans ❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons ❑ Lawn Sprinkler System-Number of Heads ❑ Well * ** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.*' ❑ Other or abandoned r six s.I hereby certify t I have rea this p becomes void if work domo co be truueeand correct. All provisions of lawsa six month period or ork is and ordir1ancl sdgoverning this work will be complied with whether specified this opplication and know the same or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction. Property Owners Name Eatf_---- o Aacoc K ,Phone Number Office Phone a. &, -3 S f3 c Fax 4,.)�-3'75 Plumbing Company "^� - Co. Address: a 3 d a r t,r ..) `" uthor ( C.=( Zip a Z24C �„, 1L©d t"^ State Certification/Registration# �tL 0 J3 5Q3 License Holder (Print): G-c..6.)�..- eg---k-•—,' Notarized Signature of License Holder . IA •: of !'�l,4Rcl4 20 t8 ' +'4 am and subscribed before n s J Y' Y, LORI NORQGREN ,/ r° V; NotaryPublic-State of Florida, ' j . ` L , Awl./ 4 . •� Commission N fF 947336 S nature of Notary Public 4, ,,�„' • ' My Comm.Expires Mar 10,2020 l / '''4'n i�'* Bonded through National Notary Assn r5�.1i1r/� Cash Register Receipt Receipt Number City of Atlantic Beach R4477 DESCRIPTION I ACCOUNT QTY PAID PermitTRAK $271.63 PLR518-0062 Address: 1769 ATLANTIC BEACH DR APN: 169505 1475 $271.63 PLUMBING $265.00 PLUMBING BASE FEE 455-0000-322-1000 0 $55.00 PLUMBING FIXTURES 455-0000-322-1000 30 $210.00 STATE SURCHARGES $6.63 STATE DBPR SURCHARGE 455-0000-208-0600 0 $3.98 STATE DCA SURCHARGE 45500002080700 0 $2.65 TOTAL FEES PAID BY RECEIPT: R4477 $271.63 CITY OF ATLANTIC BEACH 800 SEMINOLE RD ATLANTIC BEAC,FL 32233 03/12/2018 15:47:15 CREDIT CARD VISA SALE Card# XXX)00000(XXX8414 SEQ#: 6 Balch#: 560 INVOICE Approval Code: 0644 Entry Method: Mode: Manual Tax Amount: Online Card Code: 0,00 M SA[E AMOUNT $271.63 CUSTOMER COPY Date Paid: Monday, March 12, 2018 Paid By: B & G PLUMBING, HEATING & AIR Cashier: BA Pay Method: CREDIT CARD 7 Printed: Monday, March 12, 2018 3:47 PM 1 of 1 TR.K T