1855 Hickory Ln PLRS19-0192 Water Heater I? -"'\'r
PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
� PLRS19-0192
V� CITY OF ATLANTIC BEACH
�� ' ISSUED: 10/7/2019
800 SEMINOLE ROAD
0.1119" ATLANTIC BEACH. FL 32233 EXPIRES: 4/4/2020
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: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
1855 HICKORY LN PLUMBING RESIDENTIAL WATER HEATER $215.00
TYPE OF REAL ESTATE i ZONING: I BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172020 1434 SELVA MARINA UNIT
12C R/P
COMPANY: ADDRESS: CITY: STATE: I ZIP:
A J MOREL PLUMBING INC 8915 CASTLE ROCK DR JACKSONVILLE FL 32221
OWNER: ADDRESS: CITY: STATE: ZIP:
MAIN EDNA DEWEY 1855 HICKORY LN ATLANTIC BEACH FL 32233
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.
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 1 $7.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$66.00
Issued Date: 10/7/2019 1 of 2
rt'-'I4t PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
�� PLRS19-0192
CITY OF ATLANTIC BEACH
,-5,41 V ft
800 SEMINOLE ROAD ISSUED: 10/7/2019
\`'-'.1.01119''' ATLANTIC BEACH. FL 32233 EXPIRES: 4/4/2020
Issued Date. 10/7/2019 2 of 2
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s� Cash Register Receipt Receipt Number
�� City of Atlantic Beach R10673
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DESCRIPTION I ACCOUNT I QTY I PAID
PermitTRAK $66.00
PLRS19-0192 Address: 1855 HICKORY LN APN: 172020 1434 $66.00
PLUMBING $62.00
PLUMBING BASE FEE 1 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 1 $7.00
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: R10673 $66.00
Date Paid: Monday, October 07, 2019
Paid By: A J MOREL PLUMBING INC
Cashier: CT
Pay Method: CREDIT CARD 092964
il
Printed: Monday, October 07, 2019 2:19 PM 1 of 1 i
Plumbing Permit Application **ALL INFORMATION
> > HIGHLIGHTED IN
-A�ii-- \':1 City of Atlantic Beach Building Department GRAY IS REQUIRED.
:/ 800 Seminole Rd, Atlantic Beach, FL 32233
"/ Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT �` l 2.--
,-:,,;„,,,,,,,,
JOB ADDRESS: 1 m5 H) c.K(lr1.i Ln . ,?) 1-2-)3 PROJECT VALUE$ 215°6
✓❑JEW OR REPLACEMENT INSTALLATION and/or ORE-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 _i
Other Fixtures Water Treating System
❑VIISCELLANEOUS
❑Sewer Replacement
❑Back Flow Preventer
❑Lawn Sprinkler System (number of sprinkler heads)
❑Grease Interceptor(Trap) gallons (Requires 3 sets of plans)
El Well **SJRWD Well Completion Form.Completed form to be submitted to the Building Department for final inspection. **
DOther
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: G O(gI_ gon7On /V`kli..3 Phone Number: g0LI - Oi 82-2U(12
Plumbing Company: A.J. MO h9.1 of uink)/rig in�'OfficePhone: OULl-ugi,,,'67q7Fax Hitt
Co. Address: SC)15 LDS-He Fmk_ 14. City:,.Inck no lie State: ) L Zip: 2 271
License Holder: A vH h l tr. ,\ M0 Pe Certification/Registration# CI (y(L1Co
Notarized Signature of License Holder ! C %y Z-�,,
The foregoing instrument was acknowledged before me this 7 day of Ot)ibor , 20 19, in the State of Florida,
County of ThuVQ(
JANET SUE ARDARY Signature of Notary Publi '/ ' • ' 0 I
NOTARY PUBLIC-STATE OF FLORIDA
COMMISSION#GG 248602 [Personally Known OR [ ] Produced Identification
MY COMMISSION EXPIRES 09/2112022 Type of Identification:
Updated 10/17/18