518 SELVA LAKES CIR PLRS19-0012 PLUMBING PERMIT • rS'�%1.)�.7+', PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0012
8
ISSUED: 1/14/2019
00 SEMINOLE ROAD
W9 ATLANTIC BEACH. FL 32233 EXPIRES: 7/13/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • ' i BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, i
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.
JOBADDRESS: PERMITTYPE: DESCRIPTION: VALUE OF WORK:
518 SELVA LAKES CIR PLUMBING RESIDENTIAL PLUMBING - 3 FIXTURES $1500.00
TYPE OF
ZONING: :D •
CONSTRUCTION: NUMBER: GROUP:
172027 5600 SELVA LAKES UNIT 02
COMPANY: ADDRESS:
CALL PLUMBING INC 5436 KENNERLY RD JACKSONVILLE FL 32207
• ADDRESS: CITY: STATE: ZIP:
Tara Harris Josephs 518 SELVA LAKES CIR 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.
L 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 45S-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 0 $0.00
PLUMBING FIXTURES 455-0000-322-1000 3 $21.00
STATE DBPR SURCHARGE 4S5-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 4S5-0000-208-0600 0 $2.00
TOTAL:$80.00
Issued Date: 1/14/2019 1 of 2
ALL
* INFORMATIONPlumbin Permit Application HIGHLIGHTEDIN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
n
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:PLRst9 -ob(Z
-6
JOB ADDRESS: /6 �-,°1v h .
-a e f Cf c 2X3.3 PROJECT VALUE$ �i�5-19d
❑NEW OR REPLACEMENT INSTALLATION and/or ❑RE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower
Dishwasher T 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 .Tc-e _� Water Treating System
❑MISCELLANEOUS
❑ Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler head
❑ Grease 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.**
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.
Owner Name: TG ra /-/q rt"'5 JPhone Number:
Plumbing Company:C�T�L. I/ur��J�h� Office Phone: G Gp1Fax
Co. Address: Z/ 6 !`ei��Pi/�, �c/ City: J4Csowy//1f, State:` Zip: YZz,0;7
License Holder: �� &n State Certification/Registration # C�C 0�36��d
Notarized Signature of License Holder
The foregoin strument w s acknowledged before me this�day o , 20 , in the State of Florida,
County of j V--e( CA
Signature of Notary Public
-,,=,-, a- ��A
ersonally Known OR [ ] Produced Identification x
TONIGINDLESPERGER f y of Identification:
MY COMMISSION#FF 92495
a EXPIRES:October 6,2019 Updated 10/17/18
Bonded Thru Notary Public underwiters