1721 Atlantic Beach Dr PLRS19-0224 22 Fixtures , 4
' PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
•
19-0224
CITY OF ATLANTIC BEACH PLRS19-0224
800 SEMINOLE ROAD ISSUED: 12/4/2019
ATLANTIC BEACH. FL 32233
EXPIRES: 6/1/2020
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:
1721 ATLANTIC BEACH DR PLUMBING RESIDENTIAL PLUMBING - 22 FIXTURES $10000.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169505 1435 ATLANTIC BEACH
COUNTRY CLUB UNIT 02
COMPANY: ADDRESS: CITY: STATE: ZIP:
C W WOOD PLUMBING 1328 ROMNEY ST JACKSONVILLE FL 32211
OWNER: ADDRESS: CITY: STATE: ZIP:
GREGORY A NELSON 523 SELVA LAKES CIRCLE ATLANTIC BEACH FL 32233
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 22 $154.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.14
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.09
TOTAL:$214.23
Issued Date: 12/4/2019 1 of 2
rS >:r, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
=-• -. `2 PLRS19-0224
_.. CITY OF ATLANTIC BEACH
0 i ISSUED: 12/4/2019
� 800 SEMINOLE ROAD
tip ATLANTIC BEACH. FL 32233 EXPIRES: 6/1/2020
Issued Date: 12/4/2019 2 of 2
.-stn;,, PlumbingPermit Application **ALL INFORMATION
�, �� HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
3, - 800 Seminole Rd, Atlantic Beach, FL 32233 (/ (RC
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: / 2 2.-/ 4 4`''� L � x=�`-c 4 /✓L - PROJECT VALUE $ /0��� v
❑NEW 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 3 Urinal
Kitchen Sink / Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory ,.5 Water Heater
Other Fixtures Cl/1J-)
Water Treating System
❑MISCELLANEOUS❑ 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 locallawregulationticonstruction or the performance of construction.
_'t 2
Owner Name: V J/7 Phone Number:
Plumbing Company: �j• ) CSI/6)OC. IP j Office Phone: -7 "/--6‘'d '' Fax
2Co. Address: /3 Z4 A.2 S' City: J State: �Zip:3 �L !/.
License Holder: ( "/ P
"-Id ate Certification/ egistra ion # ..-71:eOS?675f7
Notarized Signature of License Holder
C"tJ, ‘)'Lt'
The foregoi instrument as acknowledged before me this 4( day of Din , 24 ), in the State of Florida,
County of �G2D /
I
Signature of Notary Pubes`- 6A---( 0/ Pi* --,
RGER
70NIG' ' t73 [ ] Personally Known OR [ ] Produced Identification
: ' ``�!;; tAYC01JIM pdoper6 2023 Type of Identification: \A)300 — 897 -Go 1%'4 6--, g ._0
. -�:-Pew: ,RES:
^ e;?•. TTru*WYPubic UnderwrnersUpdated 10/17/18