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331 19TH ST - WATER SYSTEM PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER (---„0.A,v,m);„ f ry., CITY OF ATLANTIC BEACH PLRS18-0277 ,� ISSUED: 12/31/2018 800 SEMINOLE ROAD \ `'';Sv~ VEXPIRES: ATLANTIC BEACH. FL 32233 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: 331 19TH ST PLUMBING RESIDENTIAL WATER TREATMENT SYSTEM $899.00 TYPE OF REAL ESTATE BUILDING USE CONSTRUCTION: NUMBER: ZONING: GROUP: SUBDIVISION: 172020 1210 SELVA MARINA UNIT 12 COMPANY: ADDRESS: CITY: STATE: ZIP: AFFORDABLE WATER/KINDER INC 3760 KORI RD JACKSONVILLE FL 32257 OWNER: ADDRESS: CITY: STATE: ZIP: MAYO DAVID 331 19TH 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 TOTAL: $66.00 Issued Date: 12/31/2018 1 of 2 PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph (904)247-5826 hFa_x(904)24n7-5845 p L s S Z7 7 JOB DRESS: *� I I 1. ��CKPQI-T 1 A\-V= ?x%VN R PERMIT# ' lrG�jP? NEW R REPLACEMENT INSTALLATION: Project Valu $ TYPE OF FIXTURE QTY TYPE OF XTURE 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 I RE-PI E: 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 X.4, — Hose Bibs Urinal Kitchen Sink Vacuum Breakers Laundry TrayWater Connected Appliances Lavatory Water I{eater Other Fixtures Water Treating System i MIS ,ELLANEOUS: ❑ Se r Replacement 0 Back Flow Preventer 0 Grease Interceptor(Trap) gallons(Requires 3 sets of plans) ❑ Lavyn Sprinkler System-Number of Heads 0 Well ** ** SJ WD Well Completion Form. Completed form'to be submitted to the Building Department for final inspection.** ❑ Othr Permit btcomes 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 provisionsMof any other state or local law regulation construction or the performance of construction. Prop Owners Namesn Jt(A i' \( \ma Phone Number l0- J 1i g Company t1 rro R.1)A B Ls;- ‘ JA E fL Office Phone�2,62-a 97 Fax _ I— , ' Plumb Com an Co. Acidress: ..3'7(0 0 Ko tai Ra-c1 city JAc-ksom t l le State FL Zip 02 Z 59 i License Holder(Print): m A gK A • >K N D E State Ce ification/Registration# 000 8l 8(o {{ License Holder -�c •�- Notari�zed Signature of -�� i . Sworn and subscribed be me this day of 20 fNotary Public State of Florida y r t Dorothy M.Devore -0 fl...alfa___, d4Signature of Notary P lic 1 - A • My Commission GG 081383 eri Expires 02101N2021 i r,`l/'jJ,'� Cash Register Receipt Receipt Number City of Atlantic Beach R7730 DESCRIPTION I ACCOUNT QTY PAID PermitTRAK $132.00 PLRS18-0277 Address: 331 19TH ST APN: 172020 1210 $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 PLRS18-0301 Address: 83 W 4TH ST 2 APN: 170824 0020 $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: R7730 $132.00 CITY OF ATLANTIC BEACH 800 SENINOLE RD ATLANTIC BEAC,FL 32233 12/312018 15:19:11 CREDIT CARD VIS/,SALE Card; XXXXXXXXXXXX4996 SEQ#: 6 Batch y: 761 INVOICE 6 Approval Code: 07340C Entry Method: Marulal Mode: Online Card Code: M SALE AMOUNT $132.00 Date Paid: Monday, December 31, 201E CUSTOMER COPY Paid By: AFFORDABLE WATER/KINDER I Cashier: BA Pay Method: CREDIT CARD 6 Printed: Monday,December 31,2018 3:21 PM 1 of 1 It iwur