2347 FIDDLERS LN - PLUMBING (2) � 'r- ,1r,.
1, CITY OF ATLANTIC BEACH
- ' 800 SEMINOLE ROAD
LAIATLANTIC BEACH, FL 32233
-40109,' V INSPECTION PHONE LINE 247-5814
PLUMBING RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: PLRS18-0219
Description: PLUMBING -WATER TREATMENT SYSTEM
Estimated Value: 66
Issue Date: 9/12/2018
Expiration Date: 3/11/2019
PROPERTY ADDRESS:
Address: 2347 FIDDLERS LN
RE Number: 169463 0112
PROPERTY OWNER:
Name: HAMMOND JULIE A TRUST
Address: C/O JULIE A HAMMOND TRUSTEE5823 PIN OAK COMMONS CT
BURKE, VA 22015-2841
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: AFFORDABLE WATER/KINDER INC
Address: 3760 KORI RD SPECIALTY WATER (CONS TDS QB)
JACKSONVILLE, FL 32257
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$7,500.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845 /
JOB ADDRESS: 2 17 Rc d ERS LANE, �T uhG 'Beach PERMIT#
FL. 3 Z23 3
NEW OR REPLACEMENT INSTALLATION: Project Value$ (. Ce,00
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 lo 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 1 g 14 A M M o IJ d Phone Numbi3rb°') SS 5y o°S q
Plumbing Company Fi o k i>A$LG li1,'A TEA Office Phone2102-12/9 7 Fa�l&D--69291-
Co.
D-10292-
Co. Address: 37co0 Ri It-CJ City,�Ack.5o,1UhI to State FL Zip 3225
License Holder(Print): m A iZ K A • K 1 N O t State Ce
ification/Registration# 000 8)8(,
Notarized Signature of License Holder
Sworn and subscribed be me this LD day of f-e m be r 2018
/0%, Notary Public State of Florida (/��
Dorothy M.Devore Signature of Notary P lic Wane l
My Commission GG 081383
?a Or Expires 02/09/2021
Cash Register Receipt Receipt Number
City of Atlantic Beach R6293
DESCRIPTION I ACCOUNT QTY I PAID
PermitTRAK $66.00
PLRS18-0219 Address: 2347 FIDDLERS LN APN: 169463 0112 $66.00
PLUMBING $62.00
455-0000-322-1000 0 $55.00
455-0000-322-1000 1 $7.00
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: R6293 $66.00
Date Paid: Wednesday, September 12, 2018
Paid By: AFFORDABLE WATER/KINDER INC
Cashier: BA
Pay Method: CHECK 56191
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Printed:Wednesday,September 12,2018 8:53 AM 1 of 1 1�
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