30 17th St PLRS19-0095 Water Heater PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0095
. ISSUED: 5/15/2019
800 SEMINOLE ROAD EXPIRES: 11/11/2019
- 1Lu ATLANTIC BEACH. FL 32233
ALL • , CONFORM TO I • • r • • • •
CODE,
• CITY OF • • OF ORDINANCES .
ALL CONDITIONS OF
NOTICE:In addition[o 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.
3017TH ST PLUMBING RESIDENTIAL WATER HEATER $280.00
TYPE • SE SUBDIVISION:
•
CONSTRUCTION:
• 1695900000 OCEAN GROVE UNIT01
CONCEPT RENAISSANCE 3903 Edidin DR JACKSONVILLE FL 32277
SERVICES LLC
OWNER: ADDRESS:
DOWLIN DIANE M 3017TH ST ATLANTIC BEACH FL 32233-5810
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.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
Go
PLUMBING BASE FEE
4ss-Oooca2z-moo o
--=TOTAL:
00
PLUMBING FIXTURES
455-0000-322100p 0 $000
455.0000-322-1000 1 $2.00
PLUMBING FIXTURES $2 W
STATE OBER SURCHARGE 455-0000-2000700 0
STATEDG SURCHARGE
455-0000208-0600 0 R.00
TOTAL:$66.00
Issued Date:5/15/2019 1 of 2
"ALLINFORMATION
Plumbin BPermit Application HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: P(-RZ )(c�-D(J�S
JOB ADDRESS: '}1r\ S f (a't PROJECT VALUE$ A 92.0 U
❑NEW OR REPLACEMENT INSTALLATION and/or ORE-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
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: (Vi I'1 w io101y(u) Phone Number: 0402 B09 5 621 q
Plumbing Company: 6122JS/nOffice Phone: 13ogd �B� Fax
Co.Address: `di Cl 0& ,�J Y &AJ �✓' City:J�` State: P< Zip: �5 F 7 7 9_
License Holder: V_" U_& - St a er ification/Registration ft, I! jPIf /42 200'3
Notarized Signature of License Holder '
1
The forego' strument was acknowledged before me th!Public2
Cl- 2a�,' in the State of Florida,
County of _ r
r `"`R������-7 rr ESPEa a Signature of NotaryI Mb IONMFr 24951
Pw s a.Wb m9 Personally Know [ ] Produced Identification
y. 9omcC n4o atl� 1Lgewnlws
__ --— Type of Identification:
Updarea10/17118
i' leo
)� Register Receipt
, .
iCash
City
s>
ofAtlanticBeach R971 •
DESCRIPTION • QTY PAID
PermitTRAK $55.00
PLRS19-0095 Address: 30 17TH ST APN: 169590 0000 $55.00
PLUMBING FINAL"05/17/2019 RBE $55.00
PLUMBING FINAL"05/17/2019 RBE 45500003221002 0 $55.00
TOTALR9716 $55.00
Date Paid: Monday, July 29, 2019
Paid By: CONCEPT RENAISSANCE SERVICES LLC
Cashier: CT
Pay Method: CREDIT CARD 23970P
Printed: Monday,July 29,2019 4:31 PM 1 of 1
,wua,