350 Ocean PLRS18-0246 PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845
JOBADDRESS: 350 CCf-CIn youleUia #Resla-ozfo
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NEW OR REPLACEMENT INSTALLATION: Project Value S U6, 00
TYPE OFFLYTURE QTY TYPE of FfxTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Dram 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 OFFLYTURE QTY TYPE OFFrxTURE 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 **
"*SIRWD Well Completion Form. Completed form to be submitted to the Building Department for fmal inspection.**
❑ Other
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six nronths.I hereby certify that I have read
this application and know the same m be tune and correct. All provisions oflaws and ordinances governing this work will be comPlied with whether specified
or not. The permit does not give authorityto violate the provisions ofany other smte or local law regulation cons ction or the performance of construction.
Property Owners Name W1lIIam = Joanne— CClaP, Phone Numbe(r"')219— 895H
PlwnbingCompany AFFORDABLE wAf' & Office Phone Z41-019 Fa:�
Co. Address: 3r7to0 KO2i RCla-J city. Ack n6,lle- StateELzip 01257
License Holder(Print): 011 IZ K 11 - K 1 N D E State/cJe}'tification/Registradon# 000 618(o
Notarized Signature of License Holder
Sworn and subscribed be me this 15 day of Or-7-Ober- 2018
�✓' a*nmla uM ceGG aatF Signature of Notary
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PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS18-0246
800 SEMINOLE ROAD ISSUED:
1 ATLANTIC BEACH. FL 32233 EXPIRES-
MUST CALL
INSPECTION •NE LINE (904FOR
CODE, AND CITY OF • • OF ORDINANCES .
ALL CONDITIONS OF
NOTICE:In addition to the requirements of this permit,there maybe additional restrictions applicable to this property
that maybe found in the public records of this county,and there maybe additional permits required from other
governmental entities such as water management districts,state agencies,or federal agencies.
• • ADDRESS: . • • • •
350 OCEAN BLVD PLUMBING RESIDENTIAL Water Treatment System $66.00
ZONING:TYPE OF REALESTATE SUBDIVISION:BUILDING USE
CONSTRUCTION: NUMBER: GROUP:
1701770000 ATLANTIC BEACH
COMPANY: ADDRESS:
AFFORDABLE
WATER/KINDER INC 3760 KORI RD JACKSONVILLE FL 32257
• . ADDRESS:
GALLOWAY CHARLES M 350 OCEAN BV ATLANTIC BEACH FL 32233-5336
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
IN YOUR 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.
LIST OF • 4
Roll off container company must be on City approved list. Container Cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FWURES 455-0000-3221000 0 $000
PLUMBING FID(TURES 455-0000-322-100) 1 $7,00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
5TATEDCASURCHARGE 455-0000-208-1)5OD 0 $2A0
TOTAL:$66.00
Issued Date: