1831 Selva Marina Dr PLRS20-0127 PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
r s : PLRS20-0127
� V� CITY OF ATLANTIC BEACH$41. ISSUED: 8/27/2020
800 SEMINOLE ROAD
� ATLANTIC BEACH. FL 32233 EXPIRES: 2/23/2021
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:
ATTIC RE-PIPE FOR INTERIOR
1831 SELVA MARINA DR PLUMBING RESIDENTIAL REMODEL, REPLACE $500.00
INSULATION
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172020 0768 SELVA MARINA UNIT
10B
COMPANY: ADDRESS: CITY: STATE: ZIP:
J WHITEHEAD PLUMBING 125 DIEGO ISLAND CT ST. AUGUSTINE FL 32095
INC
OWNER: ADDRESS: CITY:
BLANCHE BRIAN A 1831 SELVA MARINA DR ATLANTIC BEACH FL 32233-5619
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 1 $7.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
Issued Date: 8/27/2020 1 of 2
I
ol_tv'r%, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
,a �s CITY OF ATLANTIC BEACH PLRS20-0127
,i yr 800 SEMINOLE ROAD ISSUED: 8/27/2020
`'''I,wilD''' ATLANTIC BEACH, FL 32233 EXPIRES: 2/23/2021
STATE DCA SURCHARGE 455-0000-208-0600 --1-7-) $2.00
TOTAL:$66.00
Issued Date:8/27/2020 2 of 2
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PlumbingPermit Application **ALL INFORMATION
S f1.y�J. Mn M HIGHLIGHTED IN
'r City of Atlantic Beach Building Department GRAY IS REQUIRED.
k,--,,„,-- 800 Seminole Rd, Atlantic Beach, FL 32233 14S-20 e)
'`"'r Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 6431 SUM N\16444.- PROJECT VALUE $40
El NEW OR REPLACEMENT INSTALLATION and/or EIRE-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 1 Water Treating System
El MISCELLANEOUS P-€ 'poivt ' f tit15
❑ Sewer Replacement 70
❑ 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 re ulation consttuction or the performance of construction."`'
Ict
Owner Name: 394_, +I"` �' t Phone Number:
W\ipt
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Plumbing Company: \t & ) yY�Office Phone: ` Fax
Co. Address: D 0-k)' ) "1 City: Statedy Zip: AC
License Holder: 5—Al\ 14i) State Certifica ion/Registration l t \A-v5625
Notarized Signature of License Holder C „1
The foregoing instrument was acknowledged before me this 'day of 75U 54- , 20 "-- , the State of Florida,
County of Dvl 1 C4 �J
sig �z JENNIFER JOHNSTON Signature of Notary Public
��, • - MY COMMISSION#GG 042984
-*' �0A1� r' EXPIRES:October 27,2020
'` °` [ ] Personally Known OR [ ;roduc-• Identification
"Foy F�oP� Bonded Thru Notary Public Underwriters
-4. = Type of Identification: e.(-- 10 L
Updated 10/17/18