83 W 4TH ST - WATER TREATMENT r51''''.1/2. PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
° PLRS18-0301
,�;, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 12/31/2018
r
''tJ,t)� ATLANTIC BEACH. FL 32233 EXPIRES: 6/29/2019
•
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:
PLUMBING -WATER
83 W 4TH ST 2 PLUMBING RESIDENTIAL $66.00
TREATING SYSTEM
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170824 0020 ATLANTIC BEACH SEC H
COMPANY: ADDRESS: CITY: STATE: I ZIP:
AFFORDABLE 3760 KORI RD JACKSONVILLE FL 32257
WATER/KINDER INC
OWNER: ADDRESS: CITY: STATE: ZIP:
LAWRENCE ABENANTI 83 W 4TH ST ATLANTIC BEACH FL 32233-
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: 12/31/2018 1 of 2
,,;,5� ''�',,, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
�' 'fr.'. J PLRS18-0301
CITY OF ATLANTIC BEACH
ov ' VISSUED: 12/31/2018
800 SEMINOLE ROAD
".:1.01119',' EXPIRES: 6/29/2019
ATLANTIC BEACH. FL 32233
TOTAL: $66.00
Issued Date: 12/31/2018 2 of 2
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax(904)247-5845 s _ 0 3 O l
JOB ADDRESS: U� , (.„3. - - R. PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$ (Q,10
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 Vacuum Breakers
Laundry TrayWater Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System —i RE-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 Vacuum Breakers
Laundry Tray Water Connected Appliances
LavatoryWater Heater
Other Fixtures Water Treating System
MISCELLANEOUS: (Requires 3 sets of plans)
c Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons
❑ Lawn Sprinkler System-Number of Heads 0 Well **
** SJRWD Well Completion Form. Completed form/0 be submitted to the Building Department for final inspection.**
o 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. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name
La2,2 1 A 4- Phone NumberNl a-S _
Plumbing Company I�1 ci- li��
//�� FF°R RDAs WA -E R Office Phoneo21o2-oi97 Fa�b UO-1o292-
Co. Address: 3'7.a 0 KD is 1 R Oa-CJ City SAc-kSom,I le State FL Zip 022-59
License Holder(Print): m A IZ K A . I<i tJ D E State Ce ification/Registration# 000 6/8 Go
Notarized Signature of License Holder ��
Sworn and subscribed be me this (� day of -b- � ._ . 201 $
Notary rotr y M oe�ore Florida
Signature of Notary P lie IA.i..i'!ke ift Lara,
Ilry ComrMatbn Ct 081353ill
�a xPiros OTi09/1021
e,ukia..t- 04 119 It
. 11.5 g,,3o Og co AFFORDABLE WATER
CONDITIONING • SOFTENING • PURIFICATION
3760 Kori Road • Jacksonville, FL 32257
(904) 262-0197 • Fax (904) 260-6292
\J a .(,p AffordableWater@AffordableWaterJax.com I2 , Z 4R'
NAME 4--A---- TR LI .R ,JA:J i I DATE .14. . .ti: ti,'> s;:-. .
ADDRESS .� W, 1-4+1'-' .<-.--k-- • CITY A 4-1 - --r=Ck 1
STATE t'• ( , ZIP 2-�- PHONE . . I(r — 1-4 Cr7CD
Water Supply City l' Well ❑ Install Date 1 Zir. 9-f 0 Loop L-a 'p +
Hardness Total (lime) / g.p.g. \
Iron (rust) p.p.m. Drain-,441c- --k-•(=:, -•:—A Pipe R-f --k-?I�e
pH -- 4-Lt ---P/ 2--.
Hydrogen Sulfide Electric \ka v/ Faucet
TDS
Free Chlorine a p.p.m.
Number of Persons in Family
SALT ROUTE (, Call First ❑ Drop Off ❑ Spigot
Location of Equipent )4 51 Cam 4-U
Cross Streets /772 -1-- -;-- .-f-- '') - / 'y -1-2-1 5--1---- •
Area "--2-7.4 5-1 Pc5 __1--
DESCRIPTION MODEL PRICE WARRANTY
A K— X-5-1- /A/Illi I I t cl Labor: 1 yam-
i s�--ill r-j— ,r"1,--),r"1,--) • lIN1/ 1C.�1• 1 IS Tanks: 1 0 Li t--.4✓
(Q---- ,A.6-,-,. /--i-- ' > Valve Body: S- Li
All Pars: ��
1
Sub Total I '1'4
Sales Tam Q In 117 q t - tom
Permit/Countymelon-Taxabl .1 —_
Total I I '— "\� -Dc--- l' "'
Down Payment..1.0 Vi ° 121 1 n V,.9 A'/' ....v..--, -..:.. .....,..m4,...&,. ��
Balancp Due.( ..../.d : -a-- ( e * { ,--7, .z ..,f.
1-A ti-sat.,./C- - a�� ' V S-A 1--4 LA. ,..-4( .. : _..• , ,; .,� •.. .�
Termsr,/� r�i t .c
BUYER'(S') RIGHT TO CANCEL. This is a home solicitation sale and if you do no . : .:•• •o eNlt' s, you may cancel this agreement
by mailing a notice to the seller. This notice must indicate that you do not want the goods and must be postmarked before midnight of the third
business day after you sign this agreement.
Affordable Water is responsible for repairing equipment only under warranty and at a charge thereafter.Under no circumstances shall Affordable Water
be responsible for damages to any structure, not damaged by Affordable Water. Specifically, Affordable Water shall not be liable for any damages,
direct or consequential,to persons or property not caused by its own negligence.
The ownership of the equipment covered in this order shall remain with the seller until equipment Is paid for in full. It is further agreed by the
purchaser that the seller cannot be responsible for conditions resulting from existing facilities,changes in mineral content or color of water supply,outside
drainage,pump,sand,weather,or conditions beyo d the seller's control. t rchaser shall be r spon 'ble for w tec:tion.
date 1 Z it
Representative 6--"'%'7 . __S---1--c,:-1Purch.��
License#W-32