1851 SELVA MARINA DR - PLUMBING (--
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' s\ CITY OF ATLANTIC BEACH
.; .: _ , -) 800 SEMINOLE ROAD
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ATLANTIC BEACH, FL 32233
r� - iv%' v INSPECTION PHONE LINE 247-5814
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PLUMBING RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: PLRS18-0223
Description: PLUMBING - 7 FIXTURES
Estimated Value: 500
Issue Date: 9/17/2018
Expiration Date: 3/16/2019
PROPERTY ADDRESS:
Address: 1851 SELVA MARINA DR
RE Number: 172020 0842
PROPERTY OWNER:
Name: DICKEY STEVEN T
Address: 1851 SELVA MARINA DR
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
,
Phone:
Name: HARRY L HAYES PLUMBING INC
Address: 130 ARLINGTON RD S HARRY L HAYES
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$7,500.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904) 247-5845 ' 1 L i S ( g _C.J z 'z3
JOB ADDRESS: \ j 5 ( "5 - k j( c-.► CY\ c-,.r- t €'t c.> IX ✓%(9 3T3 PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$ „�/ t
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub ___A__ Septic Tank&Pit
Clothes Washer Shower ___1_
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet _
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Watcr Connected Appliances
Lavatory 3 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 0 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.
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Property Owners Name
_\\\i c:x 4". ,t-e V% G -7.yPhone Number tap ci 9— d C)
Plumbing Company Et G,r-r.DL 4 G.. �� t~'' l ..+•4.lD I.c.>. Office Phone 6O, — Z3 0
Co. Address: t'5d Ar \Z k \t2d 5 . City 7 c..-tc. State\\• Zip --.3"."2,-2,‘C ,
License Holder(Print): k-4c:..*.r•-3l-ac-- c..��S State Certification/Registration#c Fc I4 1055
Notarized Signature of License Holder �-Or--.-3l/ '
Sworn and subscribed before me this I LI day of e f I r 201 g'
0.00 ikee, Notary Public State of Florida
Lindsey N.Moody
Vo` df E PC s 06/0112 21 110673 Signature of Notary Public ,rili0 t72t
S` ' fir✓
Cash Register Receipt Receipt Number
f14City of Atlantic Beach R6365
DESCRIPTION I ACCOUNT QTY PAID
PermitTRAK $108.00
PLRS18-0223 Address: 1851 SELVA MARINA DR APN: 172020 0842 $108.00
PLUMBING $104.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 7 $49.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R6365 $108.00
Date Paid: Monday, September 17, 2018
Paid By: HARRY L HAYES PLUMBING INC
Cashier: CB
Pay Method: CREDIT CARD 153002
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Printed: Monday,September 17,2018 3:29 PM 1 of 1