371 4th PLRS18-0257r7ALLWORK
PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACHPLR518-0257
800 SEMINOLE ROAD ISSUED: 10/25/2018
ATLANTIC BEACH. FL 32233 EXPIRES:4/23/2019
MUST • • • E ,• • • • • • • • •ALL • • • OF PERMIT APPLY, PLEASE READ CAREFULLY.
n to the requirements of this permit,there may be additional restrictions applicable to this property
in the public records of this county,and there maybe additional permits required from other
ies such as water management districts,state agencies,or federal agencies.
• . .D. . . • OF • •
3714TH ST PLUMBING RESIDENTIAL Water Heater Replacement $825.00
OF SUBDIVISION:BUILDING USE
CONSTRUCTION: NUMBER: GROUP:
169845 0000 ATLANTIC BEACH
COMPANY: DD
JERRY NOLAN PLUMBING 3115 HAMPSTED DR JACKSONVILLE FL 32225
INC
• ADDRESS:
DENAZARIE JULES W 300 DEVON DR BURR RIDGE IL 60527-8316
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 CONDITIONS
Roll off container company must be on City approved list. Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAIDANIOUNT
PLUMBING BASE FEE 455-0000-3225000 0 $55.00
PLUMBING FIXTURES 455-0004322-1000 0 �'oo
PLUMBING FIXTURES 455-0004322-1" 1 $7.00
STATE 00PR SURCHARGE 455-0004208-0)00 0
STATE OCASURCHARGE 455-000620&0600 0 $2'�
TOTAL:$66.00
Issued Date:10/25/2018 1 of 2
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax (904)247-5845
JOB ADDRESS: 3 1 /�'1 I'O�^'u-, S f- PERMIT#
NEW OR REPLACEMENT INSTALLATION: ProjectValne$ 8200
TYPEOFFIXTURE 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 —J—
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.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 76e permit does not give autho
trinty to violate the provisions of any other state or local law regulation construction or the performance of construction.
J
Property Owners Name L A] 1,? 4 r-,<- Phone Number 626 -/t`0 t
Plumbing Company 2cra No I2 P/,rt6r4. �rN�- Office Phone 9ff -605/ Fax LYl' frS-y6
Co. Address: 3415/++�rb "^� dr _ City State FL Zip3-Z;.S
License Holder(Print): J. N^ State Certification/Registration#
Notarized Signature of License Holder ''�-
�;IS"„.•.., worn and subscribed b e me this�aa)`of 201&$y/�� 9; MY COJAWMl#sEON#GGWGG 2553.11
>{�`;r.'e`3 IXPIRF&:Seer620Y1 ignature of Notary Pub ' f�ntu
".•p;i;°`` Badetllwtblm PubAeU�keiwwen