1801 Selva Marina Dr PLRS19-0231 15 Fixtures `' PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
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CITY OF ATLANTIC BEACH PLRS19-0231
�.)f0 ISSUED: 12/19/2019
,, 800 SEMINOLE ROAD
moll v ATLANTIC BEACH. FL 32233 EXPIRES: 6/16/2020
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:
1801 SELVA MARINA DR PLUMBING RESIDENTIAL PLUMBING - 15 FIXTURES $0.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172020 0706 SELVA MARINA UNIT 10
COMPANY: ADDRESS: CITY: STATE: ZIP:
COOKS EAST COAST
PLUMBING 4850 OUTRIGGER DR JACKSONVILLE FL 32225
OWNER: ADDRESS: CITY: STATE: ZIP:
JENNIFER & CURTIS HILL 10 10TH ST 38 ATLANTIC BEACH FL 32 233
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 15 $105.00
STATE DBPR SURCHARGE 455-0000-208 0700 0 $2.40
STATE DCA SURCHARGE 455-0000-208 0600 0 $2.00
TOTAL: $164.40
Issued Date: 12/19/2019 1 of 2
�-.0--u!r,,„ PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
i,...-.. '.!;\ CITY OF ATLANTIC BEACH PLRS19-0231
X11 _.,;
800 SEMINOLE ROAD ISSUED: 12/19/2019
'=`'. ATLANTIC BEACH. FL 32233 EXPIRES: 6/16/2020
Issued Date: 12/19/2019 2 of 2
7LRSi 9 _ o -G1
.-sr,,,,, Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
. City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 SeminoleRd, AtlanticBeach, FL 32233
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Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: PES ) cr- 0 333
JOB ADDRESS: 18.v / SF (- \.l - j-v, p r II >vfc nr r (fit- PROJECT VALUE $ [ 0 C
❑NEW OR REPLACEMENT INSTALLATION and/or DRE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub _L__ Septic Tank & Pit
Clothes Washer Shower
Dishwasher i Shower Pan I
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet -D—
Hose Bibs -j Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray { Water Connected Appliances
Lavatory l'f' Water Heater i
Other Fixtures /-- Water Treating System
Iii MISCELLANEOUS t �J
L Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler heads)
❑ Grease 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 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: ,1 F h ,v. I F E 2 L_4 i5 L L Phone Number: 4--/(-, S G/ cr (.--
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Plumbing Company: C D D 14 S A S 1 /)J' Office Phone: %1-(L. ,-t 3 1/..S (-r Fax
Co. Address: y t5 O O (j-f-0 I's F. /)()/' I L City: 7 A L State: gZip: 3 > D S
License Holder: e.,..4r., C:P,-,)- State Certification/Registration # CF Co 9v a c <
r
Notarized Signature of License Holder I 0 6 ! L. CU O i ) O•
The foregoiinstrument pas acknowledged before me this I 9 day . - C)_ , 2dn in the State of Florida,
County of 0\/' .---
Signature of Notary Publi G}„ /
y;r ;Oi41 GINDLESPERGER
= ►�rccMMlssioN#GG 178 [�1-fsersonally Known OR [ ] Produced Identification
'" "' EXPIRES:October 6,2023
�'i��`°' PublicundenrtNerg Type of Identification:
' oin°P goaded Ttxu Notary
Updated 10/17/18