351 Seminole Rd PLRS21-0143 15 Plumb Fixtures PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS21-0143
Jir v~ 800 SEMINOLE ROAD ISSUED: 9/21/2021
ATLANTIC BEACH. FL 32233 EXPIRES: 3/20/2022
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:
351 SEMINOLE RD PLUMBING RESIDENTIAL 15 Plumbing Fixtures $5300.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170434 0005 SALTAIR ACRES SEC 02
COMPANY: ADDRESS: CITY: STATE: ZIP:
A T & ASSOCIATES 10337 DRIFTWOOD RD JACKSONVILLE FL 32246
OWNER: ADDRESS: CITY: STATE: ZIP:
PETERSON HELEN M 351 SEMINOLE RD ATLANTIC BEACH FL 32233-4144
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.
FEES
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 15 $105.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.40
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$164.40
Issued Date:9/21/2021 1 of 2
PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
'1 CITY OF ATLANTIC BEACH PLRS21-0143
ISSUED: 9/21/2021
/� 800 SEMINOLE ROAD
`'j;j'` v BEFL 32233EXPIRES: 3/20/2022
ATLANTICBEACH.
Issued Date:9/21/2021 2 of 2
,:rim'��•,,
Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
2 471- City of Atlantic Beach Building Department GRAY IS REQUIRED.
fl
' v 800 Seminole Rd, Atlantic Beach, FL 32233
ors sfe Phone: (904) 247-5826 Email: Buildink-Dept@coab.us PERMIT#:
JOB ADDRESS: 3� s 7- io//� )0 �lAn/G7ROJECT VALUE $ 3 U' O
DfW OR REPLACEMENT INSTALLATION and/orLIRE-PIPE
TYPE OF FIXTURE Q,�!' TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer 4 Shower /
Dishwasher f Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet o�
Hose BibsUrinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 3 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. �,C1 / /rte
Owner Name: P�93 /Ci-toJ 'r'"L Phone Number: (71/9 i ) .. K 4- Z
Plumbing Company: 6;it d- / S-SC 24/, S f1t . Office Phone:(4 4 71 a^(r69 flax
Co. Address:) 4/66 �/� li
bb � �c 1-. City: `�/�� State-j Zip: 3)-02 0 9
License Holder: 14/i(77k7 771c1/ti43 DC State Certification/Registration # d.n ` '1267 (6
L
Notarized Signature of License Holder s c�:-----
The foregoing instrument was acknowledged before me this 21 day of SEP7E1)'1B0220 2.), in the State of Florida,
County of p 1 V I4 L
�` , CHRISTIAN GILEB C A� �,
;,: :*: MYCOMMISSIONdHH1t7 a Signature of Notary Public � %
..%�b/ EXPIRES:April 13,2025 t1 //
?Rf ti., Bonded ThiuNotary PubliicUneen,a:rs [ 1 Personally Known OR [ ]'Produced Identification
Type of Identification: FL. n. L_-
Updated 10/17/18