160 11th St PLRS21-0159 27 Plumb Fixtures 44,-51-7-:\-67,---1,-,, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
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CITY OF ATLANTIC BEACH PLRS21-0159
�r 800 SEMINOLE ROAD ISSUED: 10/22/2021
J1119' ATLANTIC BEACH, FL 32233 EXPIRES: 4/20/2022
° w_ , 4 L"'I ' ,_.;,ON 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: j PERMIT TYPE: DESCRIPTION: i VALUE OF WORK:
27 Plumb Fixtures: 2nd
160 11TH ST PLUMBING RESIDENTIAL FLOOR ADDITION / REMOVE $17500.00
ROOF
TYPE OF i REAL ESTATE ZONING: I BUILDING USE SUBDIVISION:
CONSTRUCTION: : NUMBER: GROUP:
170256 0000 ATLANTIC BEACH
COMPANY: ; ADDRESS: CITY: STATE: ZIP:
TDG PLUMBING 4426 LOYS DR JACKSONVILLE FL 32246
OWNER: ADDRESS: j CITY: STATE: ZIP:
MORRIS JONATHAN 160 11TH ST ATLANTIC BEACH FL 32233
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.
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
I PLUMBING FIXTURES 455-0000-322-1000 27 $189.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.66
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.44
Issued Date:10/22/2021 1 of 2
PlumbingPermit Application **ALL INFORMATION
ri""�L�r/,: pp HIGHLIGHTED IN
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`� City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
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° Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 1(o0 \\-V` PROJECT VALUE $ ( 1,SQ0.0'0
❑NEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub __L__ Septic Tank& Pit
Clothes Washer 2 Shower —
Dishwasher
-3,--- Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet _12_
Hose Bibs y Urinal
Kitchen Sink 1 Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 4— Water Heater _
Other Fixtures --\—_ Water Treating System
❑MISCELLANEOUS
Li Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler heads)
❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
❑ Well **SJR WD Well Completion Form.Completed form to be submitted to the Building Department for final inspectio **
❑ 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: reoer\S -TOt•A h Phone Number:
Plumbing Company77b L ct..%-f-ty:1
9 Office Phone: —LtS --)Z4 I Fax S'toM — (gSS
Co. Address: L—it. Lo`., PO-- City: ....VA t State: FL. Zip: -Y2.Z.9L
License Holder77Q.AJ ZS CnAZAti State Certification/Registration # G FC-(42.-)0cz•
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this 22- day of OCT , 20 2.1, in the State of Florida,
County of In V(AL
1.,t/t,
m.a+ � e Signature of Notary Public cii/p/-c .,„ _A./
CHRISTIAN GILES
" ;. MYCOMMISSION#HH117153 [ ] Personally Known OR [ roduced Identification
-lb:,- - f EXPIRES:April 13,2025 F _ L
�",. , . Type of Identification: L-,
.A,,,,, Bonded Thru Notary PubUc Underwdten
`� Updated 10/17/18