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1673 ATLANTIC BEACH DR - PLRS20-0042 01-41:r , PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER SOw � PLRS20-0042 CITY OFS00SEMINOLE ATLANTICROAD BEACH 0 -- ISSUED: 3/24/2020 ^`on yr ATLANTIC BEACH. FL 32233 EXPIRES: 9/20/2020 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: 1673 ATLANTIC BEACH DR PLUMBING RESIDENTIAL WATER TREATMENT SYSTEM $1599.00 TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION: CONSTRUCTION: NUMBER: GROUP: 169505 1360 ATLANTIC BEACH COUNTRY CLUB UNIT 02 COMPANY: ADDRESS: CITY: STATE: ZIP: AFFORDABLE WATER/KINDER INC 3760 KORI RD JACKSONVILLE FL 32257 OWNER: ADDRESS: CITY: STATE: ZIP: SCOTT B JASINSKI RESTATED 1990 1697 Atlantic Beach Dr Atlantic Beach FL 32233 REVOCABLE TRUST 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. FEES DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT PLUMBING BASE FEE 455-0000-322-1000 0 $55.00 PLUMBING FIXTURES 455-0000-322-1000 1 $7.00 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00 Issued Date:3/24/2020 1 of 2 4i"'' !<' PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER < PLRS20-0042 Vi _ . . CITY OF ATLANTIC BEACH �, 800 SEMINOLE ROAD ISSUED: 3/24/2020 �o.ri�r v ATLANTIC BEACH, FL 32233 EXPIRES: 9/20/2020 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 TOTAL:$66.00 Issued Date: 3/24/2020 2 of 2 PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph (904) 247-5826 Fax (904) 247-5845 (D LIZ) ZDc0`t z_ JOB ADDRESS: _411 Pt+ 4 @ (1/4—k \ iiPERMIT# NEW OR REPLACEMENT INSTALLATION: Project Value$ Lsj _cc) 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 Other Fixtures Water Treating System ` RE-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 Other Fixtures Water Treating System MISCELLANEOUS: ❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons(Requires 3 sets of plans) ❑ Lawn Sprinkler System-Number of Heads Li 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 of/her state or local law regulation construction or the performance of construction. Property Owners Name Ehai _ JAr�\r\,S l;..l Phone Numberl``'4C1— �,Q-1 1.9 Plumbing Company A FFoizDABLC. WA �E/ Office Phone a2(o2-pi97 Fa�0 LD-1o292- Co. Address: -.3'7u,0 Ko k' i R OCJ City JAc k5onu i I e State FL Zip 32 2-5 r7 License Holder(Print): m A g K A • KI D E State Ce ification/Registration # 000 6l 8(c �� - Notarized Signature of License Holder ��( � Sworn and subscribed be me this (L day of \----ek) . - 20 O ,� Notary Public State of Florida 4411 • Dorothy M.Devore Signature of Notary P lie . »Myce".mroswr,c; 6"e3 E■pres 02109!2021 • �S 'lf s Cash Register Receipt Receipt Number City of Atlantic Beach R12036 DESCRIPTION ACCOUNT QTY PAID PermitTRAK $66.00 PLRS20-0042 Address: 1673 ATLANTIC BEACH DR APN: 169505 1360 $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: R12036 $66.00 Date Paid: Tuesday, March 24, 2020 Paid By: AFFORDABLE WATER/KINDER INC Cashier: FJ Pay Method: CREDIT CARD 2 Printed:Tuesday, March 24,2020 10:14 AM 1 of 1