1753 E Park Ter PLRS20-0121 16 FixturesOWNER:ADDRESS:CITY:STATE:ZIP:
PETERSON ALIZA 520 MORNING SIDE DR PONTE VEDRA
BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
C W WOOD PLUMBING 1328 ROMNEY ST JACKSONVILLE FL 32211
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
172020 0410 SELVA MARINA UNIT 08
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1753 E PARK TER PLUMBING RESIDENTIAL PLUMBING - 16 FIXTURES $5000.00
FEES
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 16 $112.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.51
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $171.51
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
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.
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.
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.
1 of 2Issued Date: 8/18/2020
PERMIT NUMBER
PLRS20-0121
ISSUED: 8/18/2020
EXPIRES: 2/14/2021
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 8/18/2020
PERMIT NUMBER
PLRS20-0121
ISSUED: 8/18/2020
EXPIRES: 2/14/2021
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $171.51
PLRS20-0121 Address: 1753 E PARK TER APN: 172020 0410 $171.51
PLUMBING $167.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 16 $112.00
STATE SURCHARGES $4.51
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.51
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R12860 $171.51
Printed: Tuesday, August 18, 2020 3:49 PM
Date Paid: Tuesday, August 18, 2020
Paid By: C W WOOD PLUMBING
Pay Method: CREDIT CARD 354028153
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R12860
Plumbing Permit Application ALL INFORMATION
HIGHLIGHTED IN
A
elil."5 City of Atlantic Beach Building Department GRAY IS REQUIRED.
I r 800 Seminole Rd, Atlantic Beach, FL 32233 PL.RS? C.D-Oja I
Phone: (904) 247-5826/ Email: Building-Dept@coab.us PERMIT#:
CJ `/
JOB ADDRESS: / 713 °Lr`J reLz t • PROJECT VALUE$ -5;e•-'d U
1(EW OR REPLACEMENT INSTALLATION and/or RE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Z Septic Tank& Pit
Clothes Washer Shower
T—Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 2-
Hose Bibs Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 3 'Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS
Sewer Replacement
i
Back Flow Preventer j .--,0
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: J 5' e/! (.....4).25-p-4,4,. , Z2 Phone Number:
Plumbing Company: G l/t) 61.2"' PA""14jOffice Phone: 1722V— `./9i-- W -----____
Co. Address: i3 ZO A °/41 '7S7City: 1 a"X State:f( Zip: 3 Z Z /f
License Holder: / -46A-.. i/v" ' -'State Certi ication/Reg'stration # G/v-.26-)7
Notarized Signature of License Holder 6/t/G .tri
The foreg nstrument as acknowledged before me this 4 da of OA,. 2(n the State of Florida,
County of) 0(c -0 ti
Signature of Notary Publ. 6 Or 1kl&
I
TONIGINDLESPERGER 1 Personally Known OR ] Produced Identification
i Y., MY co ISSIGN 11 GG 353178
3 Type of Identification:
rte dc EXPIRES:October 8,..
WP.,;?:. Bonded T ru Note?Public Ur Updated 10/17/18