2036 SELVA MADERA CT PLUMB PERM .rt''` 'j.'s PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
PLRS19-0042
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 2/26/2019
9" ATLANTIC BEACH. FL 32233 EXPIRES: 8/25/2019
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: PERMITTYPE: DESCRIPTION: VALUE OF WORK:
2036 SELVA MADERA CT PLUMBING RESIDENTIAL WATER HEATER $810.00
TYPE OF
• • GROUP:
169506 1640 SELVA NORTE UNIT 02
COMPANY: ADDRESS:
DAVID GRAY PLUMBING 6491 POWERS AVENUE JACKSONVILLE FL 32217
INC.
• ADDRESS:
FREEMAN DONALD B 2036 SELVA MADERA CT ATLANTIC BEACH I'L 32233-4531
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 4SS-0000-322-1000 0 $SS.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: 2/26/2019 1 of 2
Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
J " City of Atlantic Beach Building Department GRAY IS REQUIRED.
i�
_ 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: 904 247-5826 Email: Building-Dept@coab.us PERMIT#:Pu'S(9-DO4
JOB ADDRESS: 2036 Selva Madera Court PROJECT VALUE $810.00
HIEW OR REPLACEMENT INSTALLATION and/or EIRE-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
Lavatory Water Heater 1
Other Fixtures 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 **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:FREEMAN DONALD Phone Number: (904)246-5367
Plumbing Company: David Gray Plumbing Office Phone: (904) 724-7211 Fax(904) 724-5925
Co. Address: 6491 Powers Avenue City: Jacksonville State: FL Zip: 32217
License Holder: IDA 0itL) �'2��'Lf State Certification/Registration # CFCO22586
Notarized Signature of License Holder o a4i
I
The foregoing instrument was acknowledged before me this 'A day of YUCtr4 20 in the State of Florida,
County of
'rN=PublicState of Florida Signature of Notary Publiceran GG 2a292C12022 [ .j] Personal) Known [ ] Produced Identification
hype of Identification:
Updated 10/17/18