50 Robert St PLRS21-0171 2 Plumb Fixtures ;4" 'et4.y PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
A ^ CITY OF ATLANTIC BEACH PLRS21-0171
c `t 800 SEMINOLE ROAD ISSUED: 11/15/2021
' t ATLANTIC BEACH. FL 32233 EXPIRES: 5/14/2022
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:
50 ROBERT ST PLUMBING RESIDENTIAL 2 Plumb Fixtures: Water $1200.00
Heater, Bathtub
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
COMPANY: ADDRESS: CITY: STATE: ZIP:
PREMIER PLUMBING, INC 2663 ORKNEY CT ORANGE PARK FL 32065
OWNER: ADDRESS: CITY: STATE: ZIP:
FISHBURNE KAREN 50 ROBERT ST ATLANTIC BEACH FL 32233-1927
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 455-0000-322-10000 $55.00
PLUMBING FIXTURES 455-0000-322-1000 0 $0.00
PLUMBING FIXTURES 455-0000-322-1000 2 $14.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$73.00
Issued Date:11/15/2021 1 of 2
Poilt*, ... PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS21-0171
800 SEMINOLE ROAD ISSUED: 11/15/2021
—013110' ATLANTIC BEACH. FL 32233 EXPIRES: 5/14/2022
Issued Date: 11/15/2021 2 of 2
r ' 1,/rj, Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
�y ` City of Atlantic Beach Building Department GRAY IS REQUIRED.
s,
. 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:PIPS'21 - 0171
JOB ADDRESS: L5O -RNOP-)1:+ SA' PROJECT VALUE $ I leit),
Cip
IJVEW 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 1_
Other Fixtures Water Treating System
EIVIISCELLANEOUS
❑Sewer Replacement
['Back Flow Preventer
❑Lawn Sprinkler System (number of sprinkler heads)
DGrease Interceptor (Trap) gallons (Requires 3 sets of plans)
12 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: Od y PE,+rajf rG Phone Number:
Plumbing Company: Premiei P)urviViilc� \I/1C Office Phone: 9),1-514-86,7/ Fax
Co. Address: OM Dsfi,l +;n,-1 Ade., S. 5,.,; (P City: JayState: ft• Zip: 3ZZS6
License Holder: /VlgyL ( bbS State Certification/Registration # Cfc..- /413o4c1
Notarized Signature of License Holder `.�i/ 7
The foregoing instrument was acknowledged before me this I5X'=day of tvvi41-m,4, , 20 ;1 , in the State of Florida,
Countyof V'v,vC,.l
I PubV�oa9e�y
cr hata ate of Vonda
‘k jefp
StSignature of Notary PublicE---)
lkVAet°E0rnmkss on
®� "148 17746 [4 Personally Known OR [ ] Produced Identification
11 91211202`'
43,.,.:-: EXP Type of Identification:
Updated 10/17/18