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605 Plaza plbg permit y�i'J i?✓u� CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE-2.47-5814 PLUMBING RESIDENTIAL - MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 PERMIT INFORMATION: PERMIT NO: PLRS18-0102 Description: install kitchen sink Estimated Value: 200 Issue Date: 4/20/2018 Expiration Date: 10/17/2018 PROPERTY ADDRESS: Address: 605 PLAZA RE Number: 171219 0000 PROPERTY OWNER: Name: SKOWYRA DEDY M Address: 605 PLAZA ATLANTIC BEACH, FL 32233 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: HARRY L HAYES PLUMBING INC Address: 6837 OAKWOOD DR HARRY L HAYES JACKSONVILLE, FL 32211 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$7,500. PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph (904) 247-5826 Fax(904) 247-5845 P L�S l o� JOB ADDRESS: 0 CA=(g5k PERMIT# NEW OR REPLACEMENT INSTALLATION: Project Value$ <9 TYPE of FIXTURE 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 Sink Toilet Hose Bibs Urinal Kitchen Sink —� Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory Water Heater ' Other Fixtures Water Treating System RE-PIPE: TYPE of FIXTURE 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 Sink Toilet 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 ❑ 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 Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.I hereby certify that I have read 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 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 0 a A C5 w c' c,, Phone Number g J!4-98S; Plumbing Company b4- _rr- tN L.-Or k)auffice Phone 961-7�3 a Co. Address: L-23 z) A c CityState Zip 1C� License Holder(Print): c-- State Certification/Registration# i 4-1-2--1 Notarized Signature of License Holder =�E Public State of Florida Sworn and subscribed before me this day of �R f k 20 N.Moodymission GG 110673 Signature of Notary Public 06/01/2021 tiro Cash Receipt. . • Receipt Number Register r) ofAtlanticBeach • 44 DESCRIPTION • CITY PAI D PerrnitTRAK $66.00 PLRS18-0102 Address:605 PLAZA APN: 171219 0000 $66.00 PLUMBING - _ $62.00 PLUMBING BASE FEE 455-0000-322-1000 '. 0 $55.00 PLUMBING FIXTURES 455-0000-322-1000 1 $7.00 STATE SURCHARGES STATE DBPR SURCHARGE 455-0000-208-0600 0 $2.00 STATE DCA SURCHARGE 45500002080700 0 $2.00 TOTAL FEES PAID BY RECEIPT: R4844 $66.00 CITY OF ATLANTIC BEACH _ 800 SEMINOLE RD ATLANTIC BEAC,FL 32233 04/20/2018 11:46:52 CREDIT CARD VISA SALE Card# XXXXXXX=3728 SEQ#: 2 Batch#: 589 INVOICE 2 Approval Code: 114744 Enty Method: Manual Mode: Online Card Code: M SALE AMOUNT $66.00 CUSTOMER COPY i Date Paid: Friday, April 20, 2018 Paid By: HARRY L HAYES PLUMBING INC Cashier: BA Pay Method: CREDIT CARD.2. Printed: Friday,April 20,2018 11:47 AM 1 of 1 jn macr