1793 E Park Ter PLRS19-0134 3 Fixtures PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
t CITY OF ATLANTIC BEACH PLRS19-0134
800 SEMINOLE ROAD
ISSUED: 7/10/2019
0iS19~ ATLANTIC BEACH. FL 32233 EXPIRES: 1/6/2020
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: PERM1** DESCRIPTION: VALUE OF WORK:
1793 E PARK TER PLUMBING RESIDENTIAL PLUMBING - 3 FIXTURES $750.00
TYPE OF
ZONING: :D •
• • GROUP:
172020 0418 SELVA MARINA UNIT 08
COMPANY: + • • • �®
ROLLAND REASH 11606 COLUMBIA PARK DRIVE EAST JACKSONVILLE FL 32258
PLUMBING
• ADDRESS:
NIEMCZYK TODD R 225 SHERRY DR ATLANTIC BEACH FL 32233-5237
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 . •
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 3 $21.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $80.00
Issued Date: 7/10/2019 1 of 2
i 1lJ u'vkulu"( -3 I i1JJt ylll 11 PIMLIC TION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233 j ) i`S —o I
Ph(904)247-5826 Fax (904)247-5845 9
®�ADDRESS:! /793 . � ePERMrr# ��
NEW OR REP CEMENT INST TION: Project Value$ 7E 0
TYPE OAFFD rURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&,Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking FountainSlop Sink
Floor brain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink �_ Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavato Water Heater
Other F' s ,.� Water Treating System
RE-PIPE:
TYPE OFFnavRE QTY TYPE OFFDaVRE 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
NHSCELLA�Ecus:
❑ Sewer Replac ent o Back Fl Preventer o Grease Interceptor(Trap) gallons(Requires 3 seb pkm
13 Lawn Sprinklr System-Number f
i Heads El **
**STRWD Well�COmpletion Form. mpleted form to be submitted to the d ng Department for final i nsp •on,*
❑ Other
Permit becomes void if work does not oommen within a six month period or work is suspended or abandoned for six months.I hereby certify that have roe
this application and know the same to be true and eorrect. Ali provisions of laws and ordinances governing this work will be complied with whether specifies
or not. The permit does not give authority to vio ate the provisions of any other state or local law regulation construction or the performance of consruaroa
Property Owners Name i 1 — M ` Phone,�lumber
PlumbingCom an D 770
P Y Office Phone�� --70� Faxo7�o D 6
Co. Address: �" • City �X State, Zip? 8
License Holder(Print): State Certification/Registration# �-� /
Notarized Signature of License I�Tod r
!`'•. MELODY L DEWsEY 'Worn and subscribed before nae this y o
20 �)
.; MY COMMISSION It CSC 259422 Notary Signature of Not
psPublic'
'•.�F ..sepre(nbe'r t 7,2022