1717 SELVA MARINA DR - PLRS21-0085 A-----'- :;.,-'1,-N., PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
rQx-- s. PLRS21-0085
�I.v ,�. ., P CITY OF ATLANTIC BEACH
w ' 800 SEMINOLE ROAD ISSUED: 5/19/2021
"'i3��r ATLANTIC BEACH. FL 32233 EXPIRES: 11/15/2021
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:
1717 SELVA MARINA DR PLUMBING RESIDENTIAL PRIVATE PROVIDER $26000.00
INSPECTIONS- 16 FIXTURES
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172014 0000 SELVA MARINA UNIT 05
COMPANY: ADDRESS: CITY: STATE: ZIP:
PREMIER PLUMBING, INC 2663 ORKNEY CT ORANGE PARK FL 32065
OWNER: ADDRESS: CITY: STATE: ZIP:
AUDREY and JOHN 1717 SELVA MARINA DR ATLANTIC BEACH FL 32233-5617
McGOVERN
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT Ifs
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.
I
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
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
Issued Date:5/19/2021 1 of 2
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Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
-,t;:"., Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: ke5,_ ( 7/O'(
JOB ADDRESS: /717 ' /°a /77,,.ia Dr. PROJECT VALUE $ i(7/ 6/70
El NEW OR REPLACEMENT INSTALLATION and/or ❑RE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub i Septic Tank & Pit
Clothes Washer c2 Shower _L__
Dishwasher _i___ Shower Pan J_
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 3,
Hose Bibs Urinal
Kitchen Sink __L__ Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory N Water Heater
Other Fixtures , ater Treating System
CI MISCELLANEOUS
I 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: Phone Number:
Plumbing Company: Pe/,;ef 00n4b1 Irv, Office Phone: Fax
Fax
Co. Address: /Z95'c" Tul10441 n leo pr t=i City: Ja) State: t L_ Zip: 52.15-63
/1/10
t
License Holder: 4 c L►%
/ S
State Certification/Registration # �� /` '3oL 'e/
Notarized Signature of License Holder ,A09 `� _
The fore of instrume was acknowledged before me this { q day of, O. , 2W/ in the State of Florida,
County 0 Vo 1 •
••N r Signature of Notary Public c-- .,_
pTONT GINDLESPERGER
Y COMMISSION#GG 353178
EXPIRES:October 6,2023 -]'Personally Known OR [ ] Produced Identification
dedThruNotaryPublicUnderwriters Type of Identification:
Updated 10/17/18