711 Selva Lakes Cir PLRS19-0177 Re-Pipe 13 PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
�. PLRS19-0177
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 9/19/2019
ATLANTIC BEACH, FL 32233 EXPIRES: 3/17/2020
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • '
CODE, AND OF • OF • '
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
40TICE: In addition to the requirements of this permit,there may be additional restrictions applicable to this property
hat may be found in the public records of this county, and there may be additional permits required from other
;overnmental entities such as water management districts, state agencies, or federal agencies.
DESCRIPTION: VALUE OF WORK:
JOB ADDRESS: PERMIT TYPE:
711 SELVA LAKES CIR PLUMBING RESIDENTIAL re-pipe 13 fixtures $3500.00
TYPE OF
• • GROUP:
172027 5868 SELVA LAKES UNIT 03
COMPANY: ADDRESS: '
STEEG PLUMBING 1601 MAIN STREET ATLANTIC BEACH FL 32233
COMPANY INC
• ADDRESS:
BUSH BETTY] 711 SELVA LAKES CIR ATLANTIC BEACH FL 32233-7300
YARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT
N YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
:OMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
NSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN
ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF i
toll off container company must be on City approved list . Container cannot be placed on City right-of-way.
77-
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 13 $91.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.19
STATE DCA SURCHARGE 4S5-0000-208-0600 0 $2.00
TOTAL: $150.19
Issued Date: 9/19/2019 1 of 2
�
PlumbingPermit Application **ALL INFORMATION
�� HIGHLIGHTED IN
'$ �n City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 (�
Phone: (904) 247-}5826 Email: Building-Dept@coab.us PERMIT#: ft,Q—S 11 (1)
JOB ADDRESS: & -?��Y%" /'0'�k1 L- /A > PROJECT VALUE $
F-1 NEW OR REPLACEMENT INSTALLATION and/or LJRE-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 Z Urinal
Kitchen Sink _� Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
❑MISCELLANEOUS
❑ 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.
Owner Name: 647 , /G Phone Number:
Plumbing Company: J� �D )�►� Office Phone: �`�q' Fax
Co. Address: Aw A'A/� J,- City: �Ch Stater Zip: -�Z2'�33
License Holder: l6- ,//t`� State Certification/Registration #
Notarized Signature of License Holder 1-9
The foregoing instrument was acknowledge efore met is day of S+' (] !2�(20_`, in the State of Florida,
County of t -' 41
_ Signature of Notary Public -
JENNIFER JOMSTON
MY COMMISSION#GG 042984 [D P, rsonally Known OR [ ] Produced Identification
i= EXPIRES:October 21,2020
Bonded Ttvu
P NotaryPubliicUndetvrtden Type of Identification:
r o
Updated 10/17/18