1832 Tierra Verde Dr PLRS19-0100 2 Fixtures 1= ' . PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
S�
CIN OF ATLANTIC BEACH PLRS19-0100
01
ISSUED: 5/22/2019
800 SEMINOLE ROAD EXPIRES: 11/18/2019
F" ATLANTIC BEACH.FL 32233
ALL WORK,MUST CONFORM TO THE CURRENT 6TH • • • •TI (2WIFW111 • ' • '
CODE, NEC, IPIVIC, 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 maybe additional restrictions applicable to this property
that maybe found in the public records of this county,and there maybe additional permits required from other
governmental entities such as water management districts,state agencies,or federal agencies.
1832 TIERRA VERDE DR PLUMBING RESIDENTIAL install 2 fixtures $350.00
TYPE OF • BUILDINGSUBDIVISION:
CONSTRUCTION: NUMBER: ZGROUP:
169542 5056 SELVA TIERRA
COMPANY: ADDRESS:
GREEN BUILT
CONSTRUCTION & 3653 REGENT BOULEVARD, ft306 JACKSONVILLE FL 32224
DEVELOPMENT
OWNER: ADDRESS:
KRASUTSKY EVE ET AL 1513 OCEAN FRONT NEPTUNE BEACH FL 32266
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.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0880-323-1000 0 $5500
PLUMBING FIXTURES 455-000'0-322-1000 2 $1400
STATE DBPR SURCHARGE 455-0000-208-0)00 0
STATE OCA SURCHARGE
455-0000-208-0600 0 $200
TOTAL:$73.00
Issued Date:5/22/2019 1 of 2
PlumbingPermit #Application "ALL INFORMATION
HIG® pp RAY IS GHTED IN
REQUIRE
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 ALAS 11 0 C60
Phone: (904) Email: Buildin -Det coab.us PERMITM J•r°r —nu1Ei
JOB ADDRESS: /f33I- Tea" Ven,oe Dn- Yrrb'-t" /3 PROJEcTVALUE$ 35'0. ao
MEW OR REPLACEMENT INSTALLATION and/or diE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower
Dishwasher I Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray Water Connected Appliances_
Lavatory Water Heater
Other Fixtures Water Treating System
LMISCELLANEOUS
[]Sewer Replacement
[]Back Flow Preventer
❑Lawn Sprinkler System (number of sprinkler heads)
03rease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑Well '•SJR WD 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: V_ULs {C X-As vT$ k; 4 Phone Number. g°'Y- 71/7- 311,113S_
Plumbing Company: bArew0c. I * Co..J7.✓.w Office Phone: qDV-6/9 -06V/ F1x
Co. Address: 3653 vo City: J•rM1'G State:FL Zip: c1
License Holder: OL-7 DA °',-J 4ZState Certification/Registration# CF-G /YZ9$6
Notarized Signature of License Holder U-4
', �
The foregoing instrument was acknowledged before me this qday of 4 T, 200� in the State of Florida,
Countyof UtAJ/cl,k
srou Signature of Notary Public930
G Od29B4 ` ,/z,.z9zopersonally Known OR ty Produced I entificati0nwuneemnwn Type of Identification: �� I t` 1�l o.�Lf�
l uadoreet0/17/18