2279 SEMINOLE UNIT#5 PLRS18-0205 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
�oall% INSPECTION PHONE LINE 247-5814
PLUMBING RESIDENTIAL -
MUST CALL BY 4PM FOR NEItT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: PLRS18-0205
Description: Install Water Heater
Estimated Value: 950
Issue Date: 8/28/2018
Expiration Date: 2/24/2019
PROPERTY ADDRESS:
Address: 2279 SEMINOLE RD UNIT 5
RE Number: 168345 0275
PROPERTY OWNER:
Name: STIMLER JOHN E
Address: 2279 SEMINOLE RD APT 5
ATLANTIC BEACH, FL 32233-5947
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: DAVID GRAY PLUMBING INC.
Address: 6491 POWERS AVENUE OA DAVID FRED GRAY
JACKSONVILLE, FL 32217
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$7,500.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
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Ph(904)247-5826 Fax(904) 2447-5845
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JOB ADDRESS: d� l Ern 1Dbe /1OQ�X �5 PERMIT
NEW OR REPLACEMENT INSTALLATION: Project Value$ SO
TYPE OFFixTuRE QTY TYPEOFFixTURE 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 TYPEOFFixTURE 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.1 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 whetber 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 . ) 01'n Phone Number -I py -31 d 46t*
Plumbing Company Ctvt,A C'n A-34 ellf. 6i/)a Office PhoneQa0&q-7L11Faxa0y-7L4-4i7S
Co. Address:(off l Powys ,rAxl nvi G City. )r.� C 5W,nht State_P&Zip 7Y
License Holder(Print): &111:b (')l�/ Certification/Registration# 2Z5
Notarized Signature of License Holder UII �aa
rnrt 1afYry Pi0ae 5bN alrbtka Swom and subscribed befn th��CL da of< t 20�
GrimaM Riven
MY Commitim GG 31Retp
'{Mt f eapm tanamzz Signature of Notary Public r,