870 Sailfish Dr PLRS21-0141 5 FixturesOWNER:ADDRESS:CITY:STATE:ZIP:
KANE JACQUELINE F 870 SAILFISH DR ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171161 0000 ROYAL PALMS UNIT 01
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
870 SAILFISH DR PLUMBING RESIDENTIAL PLUMBING - 5 FIXTURES $2400.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 5 $35.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $94.00
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 1Issued Date: 10/7/2021
PERMIT NUMBER
PLRS21-0141
ISSUED: 10/7/2021
EXPIRES: 4/5/2022
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $94.00
PLRS21-0141 Address: 870 SAILFISH DR APN: 171161 0000 $94.00
PLUMBING $90.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 5 $35.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R17567 $94.00
Printed: Thursday, October 7, 2021 1:11 PM
Date Paid: Thursday, October 07, 2021
Paid By: KANE JACQUELINE F
Pay Method: CREDIT CARD 192860947
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R17567
Plumbing Permit Application ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
101E,
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: I
J [ `}
c /,,,
JOB ADDRESS: 10 Sal,Cisk DV VE kr\ C'PROJECT VALUE $
6eCt.Ck aHOD1NEWORREPLACEMENTINSTALLATIONand/or RE-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 V Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory V. 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.
ROwnerName: t e V&VQ Phone Number6-5j G-(oq—c,--
Qi1
Plumbing Company: ()LAD(\ Q ( Office Phone: Fax
Co. Address: QL1(\, Q_____ City: State:Zip:
License Holder: State Certification/Registration #
Notarized Signature of License Holder C Pb.-
L,
a k O
The foreg instrument as acknowledged b ore me this I,(7)tp...---- , 202,lin the State of Florida,
County of 0r
a
Signature of Notary Publi a-
10-------Ycye4c; TONI GINDLESPERGER
r
il •.,, MY COMMISSION#GG 353178 [ ] Personally Known OR [ ] Produced Identification
a• ;°.. EXPIRES:October6,2023 , Type of Identification: l-_-_
F9F F""- Bonded Thru Notary Public Underwriters
Updated 10/17/18r