663 Selva Lakes Cir PLRS18-0264FIMUST
PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS18-0264
800 SEMINOLE ROAD ISSUED: 10/29/2018
v V ATLANTIC BEACH. FL 32233 EXPIRES:4/27/2019
ALL • •K MUST CONFORM
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
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.
JOB ADDRESS: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
663 SELVA LAKES CIR PLUMBING RESIDENTIAL $1000.00
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172027 5892 SELVA LAKES UNIT 03
COMPANY: ADDRESS:
C W WOOD PLUMBING 1328 ROMNEY ST JACKSONVILLE FL 32211
• ADDRESS:
BYERS NANCY 13753 NIGHTHAWK CT JACKSONVILLE FL 32224
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 PAID AMOUNT
PLUMBINGBASE FEE 455-0000-322-1000 0 $55.00
PLUM GING FI%TURES 458-OOOOd22-1000 12 $8400
STATEOBPR SURCHARGE 4550000-208-0200 0 $2.09
STATE DCA SURCHARGE 455-0000-208-0600 0 $300
TOTAL:$143.09
Issued Date: 10/29/2018 1 of 2
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904) 247-58226' Fax(904)247-5845
JOB ADDRESS: (7C.L7 S�i/c.- t/"'r�-f mac% P RMIT#� 'Sl8"bZ(t
K-eSIR-
NEW OR REPLACEMENT INSTALLATION: Project Value s /-
TYPE ofFIXTURE QTY TYPE oFFIXTuRE 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 oFFixTORE 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 to/be submitted to
the Building Department for final inspection.**
❑ OtherITT J�GrC/l C/h04 e� 4* 1nC/amu-/ so-'/
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 constroclion or the performance of construction.
B` S Phone Number Z V&7�
Property Owners Name/
Plumbing Company ( .�� O dplyl"A•1%� Office Phone Fax
Co. Address: ZPAoM/le _5'7-- City zj-�L-X-' StateR Zit)Y-- 9
License Holder(Print): 1V_ Gd tate Certi�ficattiigt/Regi-stration#C-/;ZOS1Uy 7
Notarized Signature of License Holder �y
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