89 Nicole Ln PLRS21-0155 Water Heater rivi--,x, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
. PLRS21-0155
CITY OF ATLANTIC BEACH ISSUED: 10/18/2021
800 SEMINOLE ROAD
1.01119 . ATLANTIC BEACH. FL 32233 EXPIRES: 4/16/2022
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:
89 NICOLE LN PLUMBING RESIDENTIAL Water Heater $2000.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169519 0840 TIFFANY BY THE SEA
COMPANY: ADDRESS: CITY: STATE: ZIP:
STEEG PLUMBING CO. INC. 1601 MAIN ST ATLANTIC BEACH FL 32233
OWNER: ADDRESS: i CITY: STATE: ZIP:
WILLIS JOHN R III 89 NICOLE LN ATLANTIC BEACH FL 32233-5979
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT II\
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 1 $7.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$66.00
Issued Date: 10/18/2021 1 of 2
t.::,�, Plumbing Permit Application **ALL INFORMATION
jt r '�'- '��' HIGHLIGHTED IN
�� City of Atlantic Beach Building Department GRAY IS REQUIRED.
•
5v800 Seminole Rd, Atlantic Beach, FL 32233
uft _ Ph ne: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 'Lgs 24 - PISS
JOB ADDRESS: f/ kt-d i X71 5;142. PROJECT VALUE$ 'OOP PP
❑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 Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
El 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: r1115 Phone Number:
Plumbing Company: ?Al L / / N- Office Phone: 2 -cif/ Fax
Co. Address: 160/ ,/iy $f City: State:F? Zip:, Z�31j
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License Holder: r,9k 5 i State Certification/Registration#4��D.3/nb
Notarized Signature of License Holder ; /f /11141 1fa
The foregoing instrument was acknowl' •:ed before me this , day of 0 CfOB6R, 20 21 , in the State of Florida,
County of OUVAV,
Signature of Notary Public C Azit
•;.►!S!!! CHRISTIAN GILES
•* :*=
v4. M1fExpIRS:April 13,2025
COMMISSION#HH117153 [ ] Personally Known OR [+�]rProduced Identification
- ��`.; WIN
aits"' BondedThu Notary Pubic Undenvdters Type of Identification: rL D ) .•
Updated 10/17/18