640 Ocean Blvd PLRS19-0208 Water Treatment System PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
�,. � PLRS19-0208
) CITY OF ATLANTIC BEACH ISSUED:SEMINOLE ROAD 11/5/2019
_ ATLANTIC BEACH. FL 32233 EXPIRES: 5/3/2020
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:
640 OCEAN BLVD PLUMBING RESIDENTIAL WATER TREATMENT SYSTEM $2100.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170135 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
DAVID GRAY PLUMBING 6491 POWERS AVENUE JACKSONVILLE FL 32217
INC.
OWNER: ADDRESS: CITY: STATE: ZIP:
GARCIA GEORGE J III 640 OCEAN BLVD ATLANTIC BEACH FL 32233-5342
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: 11/5/2019 1 of 2
�,S,:L�'rp PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
s
J ` CITY OF ATLANTIC BEACH PLRS19-0208
s,
34. ---I ISSUED: 11/5/2019
800 SEMINOLE ROAD
‘4.-..,it 9r EXPIRES: 5/3/2020 I
ATLANTIC BEACH. FL 32233
Issued Date: 11/5/2019 2 of 2
Plumbing ''*AILI:InIFC)HIv1o,l'ItI�v
Permit, Application
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,� CIty of Atlantic Beach Building Department GRAY Ia REic IREE
800 Seminole Rd, Atlantic Beach, FL 32233 -Oz-o&
"' 'j' Plane: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:_____._____.__..._�
JOB ADDRESS: 64C Oceai Blvd PROJECT VALUE $2,100.00_r_ ..____....... __
EisJIM OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE O►= FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit ________
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain _ Slop Sink _ ___
Floor 0 Pain Three Compartment Sink _______
Floor S nk: Toilet
Hose B bs Urinal __.____
Kitcher Sink Vacuum Breakers _________
Laundry Tray _ Water Connected Appliances___ _
Lavatory _ Water Heater _______
Other fixtures Water Treating System PI
____
❑VIISCELLANEOUS
_]Sewer Repl:icemE nt
_]Back Flow Preventer
E Lawn Sprinkler Svstern (number of sprinkler heads)
Clrease 'rite tceptor (Trap) gallons (Requires 3 sets of plans)
i_]Well "SJRI-VL►Wed Completion Form. Completed form to be submitted to the Building Department for final inspectior. *"`
1_]Other
I•II lSIIIMIIE 111M11111111111111uifh11iii MUM ME
Perrr it becomes void if work does not commence within a six month period or work is suspended or abandon=d for s x m i,ntiJ:s.
I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ord la ices
Bove ning this work will be complied with whether specified or not. The permit does not give authority to vic ate tl•e pro,'i> .)nh
of any other state o• local aw regulation construction or the performance of construction.
Owner IVame:Geo.ge_Garcia Phone Number: 0104)70i_28(1+.—__,_
Plurbing Company: Daviel Gray Plumbing Office Phone: (904) 724-7211 Fax 1904)7 4 59 '5
Co. Address: 6491 lower3 Avenue City: Jacksonville State: FI-___Zip: 32:.'.17_.._._.. .
SifLicew,e Holder: atItS State Certification/Registration # C,F102.2: ii----- . _._
Notarized Siynat-u,•e of license Holder
The uregoin? inst.u cert was acknowledged before me this 5 day of tiJ e 20� , in the State of F o;ida,
—
Courty of1JA) t4_.—__
/
...Pitt, Notary Public State of Florida Signa re of Notary Public Aik _ ____._____._________
4' Grimaris Rivera •
y k My Conwms�ion GG 242920
`sj dF Expires 07/30/2022 [ Personally Known OR [ ] Produced Identification
Type of Identification: __________________
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