1832 HICKORY LN PLUMB PERM PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
r V �� PLRS19-0027
CITY OF ATLANTIC BEACH
v 800 SEMINOLE ROAD
ISSUED: 1/29/2019
9` ATLANTIC BEACH. FL 32233 EXPIRES: 7/28/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL • ' K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • ' D+ 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:
1832 HICKORY LN PLUMBING RESIDENTIAL PLUMBING - 15 FIXTURES $4500.00
TYPE OF •
ZONING: :D •
! • GROUP:
172020 1450 SELVA MARINA UNIT
12C R/P
COMPANY:---- ADDRESS:
ROLLAND REASH 11606 COLUMBIA PARK DRIVE EAST JACKSONVILLE FL 32258
PLUMBING
• ADDRESS:
ARNAO ANTHONY L 1832 HICKORY LN ATLANTIC BEACH FL 32233-4515
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 • .
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 15 $105.00
STATE DBPR SURCHARGE 45S-0000-208-0700 0 $2.40
STATE DCA SURCHARGE 45S-0000-208-0600 0 $2.00
TOTAL: $164.40
Issued Date: 1/29/2019 1 of 2
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845 I ` L R S I�-a)Z7
JOB ADDRESS: PERMTr#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE of FIXTURE QTY TYPE of FIXTURE QTY
Bathtub Septic Tank&,Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain wCompariment
ink
Floor Drain Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures ; Water Treating System
RE-PIPE:
{�
TYPE of FIXTURE QTY 1 TYPE of FIXTURE QTY
Bathtub t ,� 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 Z Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans
❑ Lawn Sprinkler System-Number of Heads ❑ Well **
** SIRWD Well Completion Form. Completed form to be submitted to the Bid ng 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 m
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 specifies
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 JZ/ Phone Number
Plumbing Company lr• Office Phone,�— O�
Co. Address: City State G,Zip '
License Holder(Print): JState C ' cation/Registration#(57--<-7/7Z
Notarized Signature of License Folder
•,,,.. ,, LaooYi_DBEISEYSworn and subscribed before me this _day of 5 at)u 0 f�_20-LI
W COLOASSION M
EXPfRE&SepbmDer 17,2022 Signature of Notary Public
°! g` flooded fire N*"Pubio uu abn