2335 Fiddlers Lane PLRS19-0102 Water Heater PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
s` 04 PLRS19-0102
CITY OF ATLANTIC BEACH ISSUED: 5/30/2019
800 SEMINOLE ROAD
EXPIRES: 11/26/2019
F •:+ ATLANTIC BEACH, FL 32233
ALL • . CONFORM • I • • • r • • • • •
CODE, NEC, IPIMC, 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
F '
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.
r • iliums
2335 FIDDLERS LN PLUMBING RESIDENTIAL WATER HEATER $935.00
TYPE OF SUBDIVISION:
CONSTRUCTION:
• 1694630116 OCEANWALKUNIT01
• . rr •
DAVID GRAY PLUMBING 6491 POWERS AVENUE JACKSONVILLE FL 32217
INC.
LASCH WAYNE D 2335 FIDDLERS LN ATLANTIC BEACH FL 32233-4681
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
455-EDGE-322-1000 0 $55.00
PLUMBING BASE FEE $0 co
PLUMBING FID(TURES 455-0000-322,1000 0
055 0000-322-1000 1 $100
PLUMBING FIXTURES $2�
STATE DBPR SURCHARGE 455-0000208-0]00 0
$200
STATE DCA SURCHARGE 455-0000-208Ofi00 D
TOTAL:$66.00
Issued Date:5/30/2019 1 of 2
� FORMATION PermitApplication HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 'IDc.2S(R p
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT JF.
JOB ADDRESS: NciIPI< LnnP PROJECT VALUES '' -.-
04EW OR REPLACEMENT INSTALLATION and/or DRE•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
01v11SCELLANEOUS
[]Sewer Replacement
❑Back Flow Preventer
❑Lawn Sprinkler System (number of sprinkler heads)
03rease 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 workdoes 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.
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Owner Name: V10 140 ) Cl[SCID Phone Number: golf- co;I—
Plumbing Company:lj4, 1 (. r, 1el IA * 61nCA Office Phone: q Lq, 2,Aq-jdj, I Fax G o �a''� 11L5-
ac4t I " POworS /h^e _ Cty.ir1r tta- ,n lit. State: zip: 12-
t,Co.Address:,T --"`"`--aa`
License Holder: / w1b Gm State Certification/Registration # Q�
Notarized Signature of License Holder , --
The forego' instru ent was acknowledged before me this qday of 20�, in the State of Florida,
County of �IA�GT
Signature of Notary Public -----
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&✓ Notary P SWWSdd a FlwNe« Gnrnwls Rivera
GG III [ personally Known OR( ] Produced Identification
a%a� MY Con*nixon
E.a�a 07nQ'T°32 Type of Identification:
Upd wd I0/17/18