708 Selva Lakes Cir PLRS21-0130 3 Plumb Fixtures ,.., -
r"' PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
y °; PLRS21-0130
,� .. , CITY OF ATLANTIC BEACH
`�W ~ 800 SEMINOLE ROAD ISSUED: 8/24/2021
'. EV ATLANTIC BEACH. FL 32233 EXPIRES: 2/20/2022
MUST CALL INSPECTION PHONE UNE'(904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION a* 'M
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:
708 SELVA LAKES CIR PLUMBING RESIDENTIAL 3 Plumbing Fixtures $2175.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172027 5836 SELVA LAKES UNIT 03
COMPANY: ADDRESS: CITY: STATE: ZIP:
ADVANTAGE PLUMBING 880 MAYPORT RD JACKSONVILLE FL 32240
BEACH
' OWNER: i ADDRESS: CITY: I STATE: ZIP:
BELLOIT WHITNEY E 708 SELVA LAKES CIR ATLANTIC BEACH FL 32233-4350
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 0 $0.00
PLUMBING FIXTURES 455-0000-322-1000 3 $21.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$80.00
Issued Date 8/24/2021 1 of 2
Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
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City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
`O'; 'r Phone: (9041) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 0 cJe- `VC& La_\e_e , Cl I i-__ PROJECT VALUE $ o'/ .75-, Ce
✓?IIEW OR REPLACEMENT INSTALLATION and/or ORE-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 I
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory --L__— Water Heater
Other Fixtures Water Treating System
DVIISCELLANEOUS
El Sewer Replacement
❑Back Flow Preventer
❑Lawn Sprinkler System (number of sprinkler heads)
Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
❑ Well **SIRWD 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: 0110-e C` �6t,03-� Phone Number: C1C4 5 5 11i o
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Plumbing Company: 4 ckvet,v1 12. 1LL.vi,,� IAc Office Phone: 1ui`C Z'Ii c/64 Faxcl(Y-+-- Zai cl69I
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Co. Address: �' '''0 1/\J���t ow-} Gt City14 kA 4.1-iC ut \ State:RL Zip: Z 2:3 3
License Holder: ` 1 rt?c) 'Cl(",t ,r 'C Sta ertification/Registration t FC �` -z501c-39
Notarized Signature of License Holder Qttei
The foregoing instrument was acknowledged before me this 2A day of P i L'I j l , 20 21, in the State of Florida,
County of
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�l rY°�`` CHRISTIAN 4i. : MY COMMISSION#HH 117153 nature of Notary Public
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:V EXPIRES:April 13,2025
,!"..,'!,:fS°? Bonded Thu Notary Public Underwriters
[ ] Personally Known OR [ . Produced Identification
Type of Identification: IL. ) j
Updated 10/17/18