1021 Atlantic Blvd 953-975 Unit 12-1 PLPP20-0003 J s 'r� PLUMBING COMMERCIAL OR PERMIT NUMBER
s
ftipo MULTIFAMILY DETAILS PER
PLPP20-0003
otg ISSUED: 2/3/2020
,,,j; ,; BUILDING PLAN PERMIT EXPIRES: 8/1/2020
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:
1021 ATLANTIC BLVD 953- PLUMBING COMMERCIAL OR UNIT 12-1 FIXTURE FOR
975 MULTIFAMILY DETAILS PER INTERIOR RENO (BLOOM $5500.00
BUILDING PLAN BEHAVIORAL SVCS)
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: I NUMBER: GROUP:
177602 0040 SECTION LAND
COMPANY: ADDRESS: CITY: STATE: ZIP:
KDS VENTURES LLC 27184 Murrhee Rd. Hilliard FL 32046
OWNER: ADDRESS: CITY: STATE: ZIP:
EQUITY ONE ATLANTIC NORTH MIAMI
1600 NE MIAMI GARDENS DR FL 33179
VILLAGE INC BEACH
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 1 $7.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
Issued Date: 2/3/2020 1 of 2
PLUMBING COMMERCIAL OR PERMIT NUMBER
MULTIFAMILY DETAILS PER PLPP20-0003
ISSUED: 2/3/2020
BUILDING PLAN PERMIT EXPIRES: 8/1/2020
[ TOTAL:$66.00
Issued Date: 2/3/2020 2 of 2
v,,, Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
e, = City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 PI!pPaO-- 0003
Phone: (904) 247-5826 Finail: Building-Dept@coab.us PERMIT#01;41/14,2_67 Z
/
JOB ADDRESS: d r2/ j Li h Tic-- 4/t./0 2'5-3 --9,7.PabROJECT VALUE $
❑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
Hose Bibs Urinal
Kitchen Sink ,f Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures 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 local law regulation construction or the performance of construction.
Owner Name: (' ei£ TL.ot-'7"- ` £ 4_ Phone Number:
Plumbing Company: /—(As— VfiGii'g5' ZiZ.,G— Office Phone: ?i-2926 • 4'2,.3 Fax
Co. Address: 7/,y/7uu,,,Itt 4.0 City: //,Orp State:f Zip: O V '
License Holder: /!4 i2 . 473 State Certification/Registration 44CFC
Notarized Signature of License Holder (/ i 1.f t
(G�
The foregoing instrument was acknowledged before me this day of Fe...440.,1, 203 ()in the State of Florida,
County of r' AJctt
Signature of Notary Public
.`I�AY Pw-; JENNIFER JOHNSTON [ [ Personally Known OR [\,}'Produced Identification
• • im MY COMMISSION#GG 042984
": !Hi
N EXPIRES:October 27,2020 Type of Identification: FL k
'.FOFF:4` Bonded Thru Notary Public Underwriters
Updated 10/17/18