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1969 Brista De Mar Cir PLRS19-0176 Kitchen Remodel PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER r s; CITY OF ATLANTIC BEACH PLRS19-0176 800 SEMINOLE ROAD ISSUED: 9/20/2019 ATLANTIC BEACH. FL 32233 EXPIRES: 3/18/2020 MUST CALL INSPECTION • • • 1 i FOR .Y INSPECTION. ALL WORK MUST CONFORMTO THE CURRENTi 1 OF • ' CODE, OF • i OF • ' ALL CONDITIONS OF PERMIT • • PLEASE 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: 1969 BRISTA DE MAR CIR PLUMBING RESIDENTIAL KITCHEN REMODEL- 2 $2500.00 FIXTURES TYPE OF • CONSTRUCTION:------ GROUP: 169506 1670 SELVA NORTE UNIT 02 COMPANY: ADDRESS: F W FAIR PLUMBING CO. P.O. BOX 51558 JACKSONVILLE FL 32240 • ADDRESS: KANE PHILIP B 1969 BRISTA DE MAR CIR ATLANTIC BEACH FL 32233-4525 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. JIM LIST OF i Roll off container company must be on City approved list . Container cannot be placed on City right-of-way. t 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 2 $14.00 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 TOTAL: $73.00 Issued Date: 9/20/2019 1 of 2 PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph (904) 247-5826 Fax (904) 247-5845 PL RS 19_017P .JOB ADDRESS: j / PERMIT # I r O NEW OR REPLACEMENT INSTALLATION: Projec� Value $ o� _ TYPE OF FIXTURE QTY TYPE OF IX Y 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 1 Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory Water Heater —� Other Fixtures Water Treating System 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: ❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans) ❑ Lawn Sprinkler System-Number of Heads ❑ 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. Property Owners Name t n 4 Phone Number Plumbing Company U � A I�� "C J�yl�� Office Phoneme�7�- �� q! Faxo? ��- Z �'� Co. Address: A6. City l ,/a StatL Zip�Z Z y License Holder (Print): ieA�fe tat Certitication/RegistratiouW 37'Sh Notarized Signature of License Holder Sworn and subscribed efore me this �— day of 20 Notary Public State of Florida Jacqueline Brooks My commission GG 204482 Signature of Notary Public �00 Expires 04/08/2022 Receipt •.frLy j. J � Register • • • • • • , yr City • ' , • I G DESCRIPTION QTY ' AID PermitTRAK $73.00 PLRS19-0176 Address: 1969 BRISTA DE MAR CIR APN: 169506 1670 $73.00 PLUMBING $69.00 PLUMBING BASE FEE 455-0000-322-1000 0 $55.00 PLUMBING FIXTURES 455-0000-322-1000 2 $14.00 STATE SURCHARGES $4.00 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 TOTAL FEES PAID BY RECEIPT: R10394 $73.00 Date Paid: Friday, September 20, 2019 Paid By: F W FAIR PLUMBING CO. Cashier: CT Pay Method: CREDIT CARD 03698G Printed: Friday,September 20,2019 2:52 PM 1 of 1