543 SELVA LAKES CIR PLUMB PERM PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
� CITY OF ATLANTIC BEACH PLRS19-0031
ISSUED: 2/1/2019
800 SEMINOLE ROAD
`'gust» ATLANTIC BEACH. FL 32233 EXPIRES: 7/31/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • '
CODE, OF • 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:
543 SELVA LAKES CIR PLUMBING RESIDENTIAL plumbing 3 fixtures $500.00
TYPE OF
• • GROUP:
172027 5514 SELVA LAKES UNIT 02
COMPANY: ADDRESS: CITY:
AGT Plumbing LLC 1167 Lake Asbury Dr Green Cove Springs FL 32043
• ADDRESS:
MADDOX GARY L 171 SUNSET CI N ST AUGUSTINE FL 32080
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.
CONDITIONSLIST OF
,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 45S-0000-322-1000 3 $21.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $80.00
Issued Date: 2/1/2019 1 of 2
Plumbing Permit Application **ALL INFORMATION
fs HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233PC_I� Sl Qj -DO 3
Phone: (904) 247-5826 Email: .Building-Dept@coab.us PERMIT#:
JOB ADDRESS: _ 5;�S c L1 t&S c .1-,c PROJECT VALUE $ 500 U"
❑NEW OR REPLACEMENT INSTALLATION and/or EIRE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower
Dishwasher f 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 ,pti Water Treating System
❑MISCELLANEOUS
❑ Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler heads)
❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
❑ Well **SIRWD 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: Mo A,-.& aa! Z)l Phone Number: ?� 9 -- 73
Plumbing Company: ,a�;%��v;,,,, j}z LC1 Office Phone: 90 Fax
Co. Address: City:(/9 &ZC i State: ,9'—zip: 32Oyfs
License Holder: State Certification/Registration # / �S
Notarized Signature of License Holder
y ze
The forego, instrument as acknowledged before me thisy of — , 20-Oin the State of Florida,
County of c 111
Signature of Notary Pub
ersonally Known OR [ ] Produced Identification
7'6y••. TONIGINDLESPERGER Type of Identification:
=' MY cOMMISSION#FF 924951
EXPIRES:October 6,2019 Updated 10/17118
%�•uI�;4p` Banded Thru Notary Public Underwriters