1021 Atlantic Blvd PLPP22-0010 Bloom Behavioral 7 fixtures permitOWNER:ADDRESS:CITY:STATE:ZIP:
EQUITY ONE ATLANTIC
VILLAGE INC 1600 NE MIAMI GARDENS DR NORTH MIAMI
BEACH FL 33179
COMPANY:ADDRESS:CITY:STATE:ZIP:
Elite Plumbing Contractors
LLC 54646 Wildlife Way Callahan FL 32011
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
177602 0040 SECTION LAND
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1021 ATLANTIC BLVD 961
PLUMBING COMMERCIAL OR
MULTIFAMILY DETAILS PER
BUILDING PLAN
BLOOM EXANSION - 7
PLUMBING FIXTURES $8400.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 7 $49.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
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: 4/20/2022
PERMIT NUMBER
PLPP22-0010
ISSUED: 4/20/2022
EXPIRES: 10/17/2022
PLUMBING COMMERCIAL OR
MULTIFAMILY DETAILS PER
BUILDING PLAN PERMIT
CITY OF ATLANTIC BEACH
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $108.00
2 of 2Issued Date: 4/20/2022
PERMIT NUMBER
PLPP22-0010
ISSUED: 4/20/2022
EXPIRES: 10/17/2022
PLUMBING COMMERCIAL OR
MULTIFAMILY DETAILS PER
BUILDING PLAN PERMIT
CITY OF ATLANTIC BEACH
Plumbing Permit Application
City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 2478826 Email:
JOB ADDRESS:
[khtw OR REPLACEMENT INSTALLATION and/or
0K FIXTURE
Bathtub
Clothes Washer
Dishwasher
Drinking Fountain
Floor Drain
Floor Sink
Hose Bibs
Kitchen Sink
Laundry tray
Lavatory
Other Fixtures
O,MSCELLANEOUS
DSewer Replacement
DBack Flow Preventer
ory
a Lawn Sprinkler System (number of sprinkler heads)
PROJECT VALUE $
TYPE OR ÉtxnJRE
Septic Tank & Pit
Shower
Shower Pan
Slop Sink
Three Compartment Sink
Toilet
Urinal
Vacuum Breakers
Water Connected Appliances
Water Heater
Water Treating System
Q;rease 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
Oother
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 jaw regulation construction or the performance of construction.
Owner Name:Orw
Plumbing Company:
Co. Address:
License Holder:A YXA..I.J o
Notarized Signature of License Holder
qo-k36a-Phone Number:
Office Phone:qOY -SO Fax
City: State.Zip: 3201)
State Certification/Registration #
The foregoing instr was acknowledged before me this )day of 20a in the State of Florida,
County of
: My Comm. Expires%.
July 08, 2023
No, GG3414å0 .
Signature of Notary Public
ersonally Known OR [ ] Produced Identification
Ty e of Identification:
Updated 10/17/18
PLPP22-0010