1791 Sea Oats Dr PLRS19-0194 13 Fixtures PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0194
800 SEMINOLE ROAD ISSUED: 10/9/2019
Oij„` ry ATLANTIC BEACH. FL 32233 EXPIRES: 4/6/2020
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: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
1791 SEA OATS DR PLUMBING RESIDENTIAL PLUMBING - 13 FIXTURES - $0.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172020 0452 SELVA MARINA UNIT 08
COMPANY: ADDRESS: CITY: STATE: ZIP:• `
C W WOOD PLUMBING 1328 ROMNEY ST JACKSONVILLE FL 32211
OWNER: ' ADDRESS: CITY: STATE: ZIP:
ROBERT CHRISMAN AND 4100 QUEEN EMMAS DR #31 PRINCEVILLE HI 96722
SARAH ROGERS
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 13 $91.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.19
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $150.19
Issued Date: 10/9/2019 1 of 2
,• ::Lb, Plumbing Permit Application **ALL INFORMATION
�� HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 'PLR-SIC), -�0 (9
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 27
JOB ADDRESS: l 7 —// Sea- CJC�. S PROJECT VALUE$,3S 00---
❑NEW OR REPLACEMENT INSTALLATION and/o iRE-PIPE
TYPE OF FIXTURE qTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer _i___ Shower _Z___
Dishwasher I Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet Z
Hose Bibs l Urinal
Kitchen Sink T Vacuum Breakers
Laundry Tray Water Connected Appliances_
Lavatory .__.3_ Water Heater
Other Fixtures 1-------- Water Treating System
❑MISCELLANEOUS
❑ Sewer Replacement 1 5
❑ Back Flow Preventer
O Lawn Sprinkler System (number of sprinkler heads)
❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
O 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: /7 )/�'7( L1ufI� Phone Number:
Plumbing Company: 1-i) L-L CUOc/ 1/" .. Office Phone: 7W-66e y Fax
Co. Address: /32,c7//0/71/2C7 —5 i City: X State:I- Zip: 3L2- /.
License Holder: // �i ��Z St Certification/Registration# CA--C USX-)/7
Notarized Signature of License Holder (: l: 7----1/G
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The foregoinstrume t was acknowledged before me this ( day of,�_. . , 201 , in the State of Florida,
County of t)v0v ,
C/i
;.v.iii"'• TOMO�IESPER Signature of Notary Public ak c/J qiii
t� 6'= LIT CpMMISS1ON I GG 353178
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-'`..../izi : e'Bomerrhnjwinpubicun [ ] Personally Known OR [ 1 Produced Identification
-. — ---- Type of Identification: G— L/
Updated 10/17/18
-,s N g p Cash Re ister Receipt Receipt Number
City of Atlantic Beach R10758
DESCRIPTION I ACCOUNT I QTY PAID
PermitTRAK $55.00
PLRS19-0194 Address: 1791 SEA OATS DR APN: 172020 0452 $55.00
PLUMBING ROUGH 10/16/2019 Mi $55.00
PLUMBING ROUGH 10/16/2019 MJ 455-0000-322-1002 0 $55.00
TOTAL FEES PAID BY RECEIPT: R10758 $55.00
Date Paid: Wednesday, October 16, 2019
Paid By: C W WOOD PLUMBING
Cashier: CT
Pay Method: CREDIT CARD 037289
Printed:Wednesday, October 16, 2019 3:10 PM 1 of 1 j
J rIl� ci Cash Register Receipt Receipt Number
'� z~ City of Atlantic Beach R10758
-- 0;3
DESCRIPTION ACCOUNT I QTY PAID
PermitTRAK $55.00
PLRS19-0194 Address: 1791 SEA OATS DR APN: 172020 0452 $55.00
PLUMBING ROUGH 10/16/2019 MJ $55.00
PLUMBING ROUGH 10/16/2019 MJ 455-0000-322-1002 0 $55.00
TOTAL FEES PAID BY RECEIPT: R10758 $55.00
Date Paid: Wednesday, October 16, 2019
Paid By: C W WOOD PLUMBING
Cashier: CT
Pay Method: CREDIT CARD 037289
Printed:Wednesday, October 16, 2019 3:10 PM 1 of 1 j