2269 Fairway Villas Ln PLRS19-0198 Water Heater PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
A 5CITY OF ATLANTIC BEACH PLRS19-0198
ISSUED: 10/24/2019
800 SEMINOLE ROAD
•l. y
ATLANTIC BEACH. FL 32233 EXPIRES:4/21/2020
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:
2269 N FAIRWAY VILLAS LN PLUMBING RESIDENTIAL WATER HEATER $590.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169398 1090 FAIRWAY VILLAS
COMPANY: ADDRESS: CITY: STATE: ZIP:
CONCEPT RENAISSANCE 3903 Edidin DR JACKSONVILLE FL 32277
SERVICES LLC
OWNER: ADDRESS: CITY: STATE: ZIP:
SKOCIK COLLIN R 2269 FAIRWAY VILLAS LN N 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.
+ i. FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 U $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: 10/24/2019 1 of 2
• Tt�U�� ' PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
3 , PLRS19-0198
r, �> CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
� ISSUED: 10/24/2019
`'3 �r ATLANTIC BEACH. FL 32233 EXPIRES: 4/21/2020
Issued Date: 10/24/2019 2 of 2
111,61111.1%/111 LV 11•
City of Atlantic Beach Building Department GRAY IS REQUIRED.
i`; 800 Seminole Rd, Atlantic Beach, FL 32233 (..,'�S 19 _0t, 9
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 2269 Fairway Villas Ln N, Atlantic Beach FL, 32233 PROJECT VALUE $590.00
✓NEW 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 1
Other Fixtures Water Treating System
DVIISCELLANEOUS
❑Sewer Replacement
❑Back Flow Preventer
CI Lawn Sprinkler System (number of sprinkler heads)
Threase 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 c`i-2ws 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:COLLIN SKOCIK Phone Number: (904)226-7816
Plumbing Company: CONCEPT RENAISSANCE SERVICES Office Phone: (904) 805-5858 Fax
Co. Address: PO BOX 8152 City: JACKSONVILLE State: FL Zip: 32239
License Holder: RICARDO GRANELA State Certification/Registration # 1429637
Notarized Signature of License Holder v�
The foregoing instrument was acknowledged befor- me this 3 day of Cdbto•e r , 2019, in the State of Florida,
County of
a4` \ NMotaryichelle ieuoficTynan Signature oState of Flonda Si tf Notary Public G•
A
My Common GG 298839
Expires 04/02/2023
[ J Pers Kr wn..R_j ] Produced Identification
Type of Identification:
Updated 10/17/18
s ri,, Cash Register Receipt Receipt Number
City of Atlantic Beach R10830
DESCRIPTION I ACCOUNT QTY I PAID
PermitTRAK $66.00
PLRS19-0198 Address: 2269 N FAIRWAY VILLAS LN APN: 169398 1090 $66.00
PLUMBING $62.00
PLUMBING BASE FEE 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: R10830 $66.00
Date Paid: Thursday, October 24, 2019
Paid By: CONCEPT RENAISSANCE SERVICES LLC
Cashier: CB
Pay Method: CREDIT CARD 1
/.
Printed:Thursday,October 24, 2019 11:10 AM 1 of 1 b