1555 Selva Marina Dr PLRS19-0195 Remodel PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
.+ ~ „ a PLRS19-0195
tAor
CITY OF ATLANTIC BEACH ISSUED: 10/16/2019
800 SEMINOLE ROAD
ATLANTIC BEACH. EXPIRES: 4/13/2020
FL 32233
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:
1555 SELVA MARINA DR PLUMBING RESIDENTIAL PLUMBING REMODEL 23 $18000.00
FIXTURES
TYPE OF REAL ESTATE i BUILDING USE I
CONSTRUCTION: NUMBER: ZONING: GROUP: SUBDIVISION:
171946 0000 SELVA MARINA UNIT 02
4
COMPANY: ADDRESS: CITY: STATE: ZIP:
Clay County Master GREEN COVE
449 Arthur Moore Dr FL 32043
Plumbing LLC SPRINGS
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OWNER: ADDRESS: CITY: STATE: ZIP:
ARTHUR RICHARD 1555 Selva Marina Dr Atlantic Beach FL 32233
WORSHAM
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 23 $161.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.24
Issued Date. 10/16/2019 1 of 2
01..J.v.t. PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
,64 :� ` p CITY OF ATLANTIC BEACH PLRS19-0195
.:)yISSUED: 10/16/2019
\--,....01119)/v
800 SEMINOLE ROAD
EXPIRES:4/13/2020
ATLANTIC BEACH. FL 32233
STATE DCA SURCHARGE 455-0000-208-0600 0 $2161,
TOTAL: $221.40
Issued Date: 10/16/2019 2 of 2
Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 D L RSl Ca b( 95
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
1
JOB ADDRESS: I S5 5 SE I Jot. Q- r I v-\Q 'b r. PROJECT VALUE $ 1 S, 000
I}VEW OR REPLACEMENT INSTALLATION and/or ERE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub --I-- Septic Tank & Pit
Clothes Washer _L__ Shower
Dishwasher I Shower Pan 2
Drinking Fountain Slop Sink
Floor Drain I Three Compartment Sink
Floor Sink Toilet 3
Hose Bibs 5 Urinal
Kitchen Sink _L_ Vacuum Breakers
Laundry Tray __I___ Water Connected Appliances
Lavatory 3 Water Heater
Other Fixtures Water Treating System )
OVIISCELLANEOUS4
®Sewer Replacement 1/
EIBack Flow Preventer
['Lawn Sprinkler System (number of sprinkler heads)
Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
0 Well **SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection. **
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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: R•1 C�a-rd, �'r-L h U r- Phone Number: a 1" a ki
C.\O�is l_0 trYlc�, - I- Ce--(11:: „a _1i _ Fax oZ -- , 4vier �
Plumbing Company: 0 ice Phone:
1PI U i C3 lr L r-al.1,1 -e
Co. Address: l0 C ho..r ICS P' '^° ""'e-jCity: Q ` 1�� State:Pt Zip: 0
License Holder: v`eNQ 5 C'C • PQ k V{" y a Certification/Registration # e re m 5 'O ri
Notarized Signature of License Holder .A.
o
The forego. instrume t was acknowle ged before me this l of �0 , 2 , in the State of Florida,
County of 1-__)0VOL-
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TONIGINDLESPERGER Signature of Notary Public 5� t •
'; �q , MY COMMISSION#GG 353178
;,;•+��'o/ ,�,�E^X�PTMIR-E� S:October 6,2023 [ ] Personally Known OR [ ] Produced Identification
.f�'��P: B011tIW 11�U
Pubic
u Urdennters Type of Identification: P4 ZU 4 SI - S -1 (07 - 0
Updated 10/17/18