1811 Selva Grande Dr PLRS21-0037 Repipe, 10 Fix 0),A`„„ PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
'� f 'Or PLRS21-0037
r -.�� CITY OF ATLANTIC BEACH
u v~ 800 SEMINOLE ROAD ISSUED: 3/3/2021
'-to:31}% ATLANTIC BEACH, FL 32233 EXPIRES: 8/30/2021
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:
1811 SELVA GRANDE DR PLUMBING RESIDENTIAL PLUMBING REPIPE AND $15000.00
REMODEL 10 FIXTURES
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169542 5042 SELVA TIERRA
COMPANY: " ADDRESS: CITY: STATE: ZIP:
CELTIC CUSTOM PM BOX 118 JACKSONVILLE FL 32207
PLUMBING INC.
OWNER: ADDRESS: CITY: STATE: ZIP:
MALIE DOUGLAS R 1811 SELVA GRANDE DR ATLANTIC BEACH FL 32233-4526
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT II\
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.
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
;..
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
j PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 10 $70.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$129.00
Issued Date:3/3/2021 1 of 2
PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
r CITY OF ATLANTIC BEACH Pt RS21-0037
1 . :LI ISSUED: 3/3/2021
800 SEMINOLE ROAD
�` EXPIRES: 8/30/2021
`°ii1'` ATLANTIC BEACH. FL 32233
Issued Date:3/3/2021 2 of 2
PlumbingPermit Application **ALL INFORMATION
�s�'�`'. �� HIGHLIGHTED IN
I
City of Atlantic Beach Building Department
....,
, T,),-,,,
GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
> Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:( ES2-\ —002.f
\JOB ADDRESS: \\ c�`V e (..i---C GwC: %r PROJECT VALUE $ �C
l
❑NEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer 1 Shower
Dishwasher \ Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink 1 Vacuum Breakers
Laundry Tray 1 Water Connected Appliances
Lavatory 3 Water Heater
Other Fixtures i Water Treating System
❑MISCELLANEOUS ` 0
❑ Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler ea
❑ 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,\- R ( l--CX.•NOC Phone Number: 40L(.-3�6"L-3-1?--
Plumbing Company: CC''—\\-k.L (-:--)C\- .S" ffice PhonePt41 f 1(3(b ( ... cle(... Fax
Co. Address: 1444 — tPC -V-k_r.J/-S N./C= City: - .(kook State: k Zip: ll--1-0
License Holder: CAT"-t'�S 0` C or`�r)r State Certification/Registration ( C\ iff2; c
Notarized Signature of License Holde�
The forego ' strument s acknowledged before me this 3 d ofi nu^ 1 , 202(in the State of Florida,
County of = J v 1(CCS,
� C)`- 191—/ ,A------
vd TONIGINDLESPERGER Signature of Notary Publi
:• . MY COMMISSION#GG 353178
EXPIRES:October 6,2023 4-1-Personally Known OR [ ] P uceedIdentification
• .b.. 1��J\J\
'.'�fOFF;�!` Bonded Thru Notary Public Underwrltens Type of Identification:
Updated 10/17/18