2281 N Fairway Villas Ln PLRS19-0111 Tankless Water Heater PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
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CITY OF ATLANTIC BEACH PLRS19-0111
800 SEMINOLE ROAD ISSUED: 6/10/2019
f ATLANTIC BEACH. FL 32233 EXPIRES: 12/7/2019
MUST CALL INSPECTION ' • • 1 BY PM FOR ' •
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • '
CODE, ' OF BEACH CODEOF 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:
2281 N FAIRWAY VILLAS LN PLUMBING RESIDENTIAL TANKLESS WATER HEATER $0.00
TYPE OF
ZONING: :D •
• • GROUP:
169398 1094 FAIRWAY VILLAS
COMPANY: ADDRESS:
JOHN MOON PLUMBING 1103 PALM CIR JACKSONVILLE FL 32250
BEACH
• ADDRESS:
MOULTON PAUL DOUGLAS 2281 FAIRWAY VILLAS LA N ATLANTIC BEACH FL 32233
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 455-0000-322-1000 0 $55.00
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: $66.00
Issued Date:6/10/2019 1 of 2
Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
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City of Atlantic Beach Building Department GRAY IS REQUIRED.
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800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: ) Qi�.I V;111%a /04LC N PROJECT VALUE$
L'�NEW OR REPLACEMENT INSTALLATION and/or F-1 RE-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
U 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.
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Owner Name: QKf/�"�/ Phone Numberl. 'Ye S
Plumbing Company:� j�.� f(/t' �/J Office Phone:'F0 t(-24 / .27Ax
Co. Address: 0 (� �'N� City: P /3� State: PL Zip: _�22�? 3
License Holder: State Certificatio /Registration# cj�'-G-001`7 2dy
Notarized Signature o License Halder
The foregoig I strument w s acknowledged before me this I r")d f , 20L in the State of Florida,
County of
Signature of Notary Public L--
TONI GINDLESPERGER
MY COMMISSION#FF 924951 [ ] Personally Known OR [ ] Produced Identification
EXPIRES:October 61 2019 _
" BondedThruNotaryPublicunderwdtem Type of Identification: �n 0 �� (� S
Updated 10/17/18