1921 SELVA MARINA DR PLRS18-0300 PLRS PERMIT ,--":1-'-= ,Ly\ PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
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CITY OF ATLANTIC BEACH
PLRS18-0300
�111ISSUED: 12/28/2018
800 SEMINOLE ROAD
Z�sts>" v ATLANTIC BEACH. FL 32233 EXPIRES: 6/26/2019
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:
1921 SELVA MARINA DR PLUMBING RESIDENTIAL PLUMBING - 1 FIXTURE $500.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172020 0856 SELVA MARINA UNIT
10C
COMPANY: ADDRESS: CITY: STATE: ZIP:
HARRY L HAYES PLUMBING 130 ARLINGTON RD S JACKSONVILLE FL 32216
INC
OWNER: ADDRESS: CITY: STATE: I ZIP:
WARFLE DAYTON F JR 1921 SELVA MARINA DR ATLANTIC BEACH FL 32233-4519
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 0 $0.00
PLUMBING FIXTURES 455-0000-322-1000 1 $7.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
Issued Date: 12/28/2018 1 of 2
ALL
4`,r Plumbing Permit Application
**HIGHLI INFORMATION
ON
�' �•� gHIGHLIGHTED IN
`' tom} City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd,Atlantic Beach, FL 32233 J
~- `'' Phone: (904) 247-5826-Email: Building-Dept@coab.us PERMIT#: p LRS 18 -03O
JOB ADDRESS: 1921 Selva Marina Drive 32233 PROJECT VALUE$500.00
•
IVEW OR REPLACEMENT INSTALLATION and/or ORE-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 1 Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
DVIISCELLANEOUS
❑Sewer Replacement
❑Back Flow Preventer
❑Lawn Sprinkler System (number of sprinkler heads)
D3rease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑Well **SJRWO 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: Warfle Phone Number: (904)516-4100
Plumbing Company: Harry L 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# CFC1427058
Notarized Signature of License Holder kV
The foregoing instr ment was acknowledged be ore me this ,:;'t.` day of Oc(Prn6/ , 201 , in the State of Florida,
County of \)00...\
Signature of Notary Publics k\).N!``
"Pre, Notary Public State of Florida
4,,,: Lindsey N.Moody [ Personally Known OR[ ] Produced Identification
My Commission GG 110873
Expirea06/01/2021 Type of Identification: fs/Pr
Updated 10/17/18
-11...A.
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Cash Register Receipt Receipt Number
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City of Atlantic Beach R7722
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DESCRIPTION I ACCOUNT QTY I PAID
PermitTRAK $66.00
PLRS18-0300 Address: 1921 SELVA MARINA DR APN: 172020 0856 $66.00
PLUMBING $62.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 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: R7722 $66.00
CITY OF ATLANTIC BEACH
800 SEMINOLE RD
ATLANTIC BEAC,FL 32233
12282018 11:52:37
CREDIT CARD
VISA SALE
Card# XX X4674
SEQ#: 4
Batch#: 950
INVOICE 4
Approval Code: 028645
Entry Method: Manual
Mode: Online
Tax Amount: $0,00
Card Code: M
SALE AMOUNT $66,00
CUSTOMER COPY
Date Paid: Friday, December 28, 2018
Paid By: HARRY L HAYES PLUMBING INC
Cashier: LE
Pay Method: CREDIT CARD 4
/r
Printed: Friday, December 28,2018 11:54 AM 1 of 1 P
TRACT