362 Plaza GSRS18-0063 MECHANICAL RESIDENTIAL GAS PERMIT NUMBER
�� �� PERMIT GSRS18-0063
ISSUED: 6/4/2018
% NE
CITY OF ATLANTIC BEACH EXPIRES: 12/28/2019
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INSPECTION
• • i • , , ,, •. , • , ' •
MUST CALL i
ALL
WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • DA BUILDING
CODE, AND CITY OF • OF ORDINANCES .
ALL CONDITIONS OF PERMIT • r 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: PERMITTYPE: DESCRIPTION: VALUE OF WORK:
362 PLAZA MECHANICAL RESIDENTIAL GAS Gas Piping for for 5 Outlets $1135.00
TYPE OF
• : • •
• • GROUP:
169972 0005 ATLANTIC BEACH
COMPANY: � A• • •ESS: CITY:
CONSTRUCTION
SOLUTIONS & 5225 EDGEWOOD CT JACKSONVILLE FL 32254
• ADDRESS:
I ZIP:
MERRIAM RICHARD A 4451 MENDENHALL DR DALLAS TX 75244
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.
OF • . •
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
GAS PIPING OUTLETS 4S5-0000-322-1000 1 $10.00
GAS PIPING OUTLETS 4S5-0000-322-1000 4 $10.00
MECHANICAL BASE FEE 455-0000-322-1000 0 $SS.00
STATE DBPR SURCHARGE 455-0000-208-0600 0 $2.00
STATE DCA SURCHARGE 45500002080700 0 $2.00
TOTAL:$79.00
Issued Date: 6/4/2018 1 of 2
Revision Request/Correction to Comments **ALL INFORMATION
HIGHLIGHTED IN
Js "' City of Atlantic Beach Building Department GRAY IS REQUIRED.
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800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
0 Revision to Issued Permit OR ❑Corrections to Comments Date:
Project Address: 3 10 D, P 10,2 C\ po 11
Contractor/Contact Name: C-o r1,tc, i c]v� S-,I L,.tl(3n ri � f.,'
.1 1Contact Phone: 9 o q-�`e9- X700 Email: C 5`--'01--y\
Description of 1Proposed Revision/Corrections:
I C.ry)q.f� ROvnQ C", affirm the revision/correction to comments is inclusive of the proposed changes.
(printed name)
• Will proposed revision/corrections add additional square footage to original submittal?
[K]No F1 Yes (additional s.f.to be added: )
•no
proposed revision/corrections add additional increase in building value to original submittal?
*Yes(additional increase in buildin va e:$ `' ) (Contractor must sign if Increase in valuation)
*Signature of Contractor/Agent:)
(Office Use Only)
❑ Approved ❑ Denied ❑ Not Applicable to Department Permit Fee Due$
Revision/Plan Review Comments
Department Review Required:
Building
Planning&Zoning Reviewed By
Tree Administrator
Public Works
Public Utilities
Public Safety Date
Fire Services Updated 10/17/18
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Cash
City of Atlantic Beach R9440
DESCRIPTION • QTY PAID
PermitTRAK $10.00
GSRS18-0063 Address: 362 PLAZA APN: 169972 0005 $10.00
MECHANICAL $10.00
GAS PIPING OUTLETS 455-0000-322-1000 1 $10.00
TOTAL FEES PAID BY RECEIPT: R9440 $10.00
Date Paid: Friday, June 28, 2019
Paid By: CONSTRUCTION SOLUTIONS &
Cashier: CB
Pay Method: CREDIT CARD 3
Printed:Friday,June 28, 2019 8:38 AM 1 of 1i