1565 Selva Marina Dr PLRS19-0112 9 Fixtures PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
PLRS19-0112
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 6/12/2019
ATLANTIC BEACH. FIL 32233 EXPIRES: 12/9/2019
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: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
1565 SELVA MARINA DR PLUMBING RESIDENTIAL PLUMBING - 9 FIXTURES $7000.00
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1719450000 SELVA MARINA UNIT 02
COMPANY: ADDRESS: CITY: STATE: ZIP:
TACTICAL PLUMBING INC 595 Ashcroft Landing DR JACKSONVILLE FL 32225
OWNER: ADDRESS: CITY: STATE: ZIP.
BROOKS T DANIEL 12931 PLANTERS CREEK CIR S JACKSONVILLE F1 32224
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.
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DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 45S-0000-322-1000 0 $0.00
PLUMBING FIXTURES 45S-0000-322-1000 9 $63.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 2.00
TC
Issued Date: 6/12/2019 1 of 2
"ALL INFORMATION
Plumbing Permit Application HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 L't C) 0
Phone: (904) 247-5826 Email: Build ing-Dept@coa b.us PERMIT#:
JOB ADDRESS: 156 5 �c WOL A&-(I" A(- PROJECT VALUE$ -7(, /)/,)/)
E]NEW 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 ater Connected Appliances
Lavatory ater Heater
Other Fixtures Water Treating System
EIMISCELLANEOUS
0 Sewer Replacement
1:1 Back Flow Preventer
El Lawn Sprinkler System (number of sprinkler heads)
El Grease Interceptor (Trap)_gallons (Requires 3 sets of plans)
1:1 Well **SJRWD Well Completion Form.Completed form to be submitted to the Building Department for final inspection.
1:1 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: Chn3 �aviy,,r M, -r'lores Phone Number: tq
Plumbing Company: C el 1AN0 b," Office Phone: q
-0(/-160-q 77q Fax
city: loi -x- State: ��
Co. Address: z i p:
License Holder: ,I,, 'i re-3 -1--l"blate n/Registration # Rr M �(I-Al
Notarized Signature of License Hoilel_�
The foregoirt,(nstrument +as acknowledged befor��ethis o��Lkc i f\ 0 2019' in the State of Florida,
County o_
Signature of Notary Publi
c
TONI GINDLESPERGEIR
0 MMISSION 9249�51
My 0 #!
Personally Known OR Produced Identification
My GOM. mISSION#FF 9249511
E X S
R�'�t
PI October.6,2019
Pu'.Ur, _f'ter.'
XPIRES
ded T b d
w6ters Type of Identification: r 3 -84- - 3CE -0
S,,ded Thw Ntary Public Urder
Updated 10/17118
Cash Register Receipt Receipt Number
City of Atlantic Beach R9420
DESCRIPTION ACCOUNT CITY PAID
PermitTRAK $55.00
PLRS19-0112 Address: 1565 SELVA MARINA DR APN: 171945 0000 $55.00
PLUMBING ROUGH 06/14/2019 RBE $55.00
PLUMBING ROUGH 06/14/2019 RBE 455-0000-322-1002 0
TOTAL FEES PAID BY RECEIPT: R9420 $55.00
Date Paid: Wednesday, June 26, 2019
Paid By: TACTICAL PLUMBING INC
Cashier: CT
Pay Method: CREDIT CARD 12
00.
Printed:Wednesday,June 26, 2019 3:50 PM I
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