971 AMBERJACK LN - PLUMBING '%4 PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS18-0285
\rk. . .
800 SEMINOLE ROAD ISSUED: 11/27/2018
Oi;19%' ATLANTIC BEACH. FL 32233 EXPIRES: 5/26/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING
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:
971 AMBERJACK LN PLUMBING RESIDENTIAL Repipe $1000.00
TYPE OF REAL ESTATE I ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171173 0000 ROYAL PALMS UNIT 01
COMPANY: ADDRESS: CITY: STATE: ZIP:
HARRY L HAYES PLUMBING 130 ARLINGTON RD S JACKSONVILLE FL 32216
INC
OWNER: ADDRESS: CITY: STATE: ' ZIP:
LUNDGREN ERIK 971 AMBERJACK LN ATLANTIC BEACH FL 32233-4226
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
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 10 $70.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $129.00
Issued Date: 11/27/2018 1 of 2
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��� Plumbing Permit Application **ALL INFORMATION
s rj, HIGHLIGHTED IN
�, Pr 4r?' City of Atlantic Beach Building Department GRAY IS REQUIRED.
'''':'4' ' "1 800 Seminole Rd, Atlantic Beach, FL 32233 Q
'-,,z157,,' Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 1 LS[t U fj
-62.ES
JOB ADDRESS: 971 Amberjack Lane 32233 PROJECT VALUE$1,000.00
❑✓1IEW OR REPLACEMENT INSTALLATION and/or E-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 1 Septic Tank&Pit
Clothes Washer 1 Shower
Dishwasher 1 Shower Pan 1
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 2
Hose Bibs Urinal
Kitchen Sink 1 Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 2 Water Heater 1
Other Fixtures Water Treating System
❑MISCELLANEOUS
❑Sewer Replacement
❑Back Flow Preventer
❑Lawn Sprinkler System (number of sprinkler heads)
3rease Interceptor(Trap) gallons (Requires 3 sets of plans)
❑Well **SJRWD Well Completion Form.Completed form to be submitted to the Building Department for final inspection.**
DOther
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.
Owner Name:Lundgren Phone Number:
Plumbing Company: Harry Hayes Plumbing, Inc. Office Phone: (904)723-5609 Fax(904)329-4325
Co.Address: 130 Arlington Road South City: Jacksonville, State: Fl Zip: 32216
License Holder: Harry Hayes State Certification/Registration# CFC 1427058
Notarized Signature of License Holder
The forego g instrument was acknowledged befo a me this \ day of c.\\] , 201 %, in the State of Florida,
County of '\1'.%
Signature of Notary Publicvvt, AYs"
iv"'"s NotaLindsryeyNPubiicStateMoodyofFlorida
( ersona� llyKnown [
ORProduced Identification
VeMy Commission GG 110673 Type of Identification:
or ry
Expires 06/01/2021
Updated 10/17/18
riLI.f
\,s ', Cash Register Receipt Receipt Number
City of Atlantic Beach R7465
DESCRIPTION ACCOUNT QTY I PAID
PermitTRAK $129.00
PLRS18-0285 Address: 971 AMBERJACK LN APN: 171173 0000 $129.00
PLUMBING $125.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 10 $70.00
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: R7465 $129.00
Date Paid: Tuesday, November 27, 2018
Paid By: HARRY L HAYES PLUMBING INC
Cashier: CB
Pay Method: CREDIT CARD 27316
Printed:Tuesday, November 27,2018 4:14 PM 1 of 1 14