144 Seminole Rd PLRS21-0173 Sewer Replacement -' „ PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS21-0173
800 SEMINOLE ROAD ISSUED: 11/18/2021
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``.941. 'r J ATLANTIC BEACH, FL 32233 EXPIRES: 5/17/2022
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY IN
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORI d`
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: 1 PERMIT TYPE: f DESCRIPTION: VALUE OF WORK:
144 SEMINOLE RD PLUMBING RESIDENTIAL Sewer Replacement $2400.00
TYPE OF REAL ESTATE BUILDING USE
CONSTRUCTION: , NUMBER: ZONING: GROUP: SUBDIVISION:
170597 0000 SALTAIR SEC 01
COMPANY: ADDRESS: CITY: STATE: ZIP:
BYRNES PLUMBING AND 2374 STONEHAVEN COURT EAST ORANGE PARK FL 32065
MORE
OWNER: ADDRESS: , CITY: STATE: ZIP:
DRUMMOND KENNETH W 144 SEMINOLE RD ATLANTIC BEACH FL 32233-4141
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.
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:$66.00
Issued Date: 11/18/2021 1 of 2
PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS21-0173
800 SEMINOLE ROAD ISSUED: 11/18/2021
x sP ATLANTIC BEACH, FL 32233 EXPIRES: 5/17/2022
Issued Date: 11/18/2021 2 of 2
Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
r 1;`, City of Atlantic Beach Building Department GRAY IS REQUIRED.
•
�► 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: ilding-Dept@coab.us PERMIT#:
JOB ADDRESS: 77 .X'_VYI(c�t Ole 'Yd. PROJECT VALUE$ 4Aydd C�
❑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
Cher Fixtures Water Treating System
MISC LANEOUS
Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler heads)
❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
E 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 re lation constructi n or the performance of construction.
Owner Name: /' j (.f d J Phone Number:
Plumbing Company: 6 ( YYtes (C t (rlsikaloftice hone: q6c(-7(,. -y/4x
Co. Address: 23'7qS-64.LICtitet- � City: OfA.4,,ePa4( State: FL Zip: ?? 56y(/
License Holder: I . a . 0 S .te Certifi . .• '-gistratio # CFL /yg71
Notarized Signature of License Holder ,,allierf'__�i/_%
The foregoing instrument was acknowledged before - s ( , ay of �Q V , 20Z1;
in the State of Florida,
County of DUVflL.-
/� c ,A1./(J/1.Signature of Notary Public Gil
/0,7i:44:\ CHRISTIAN GILES
, ;+_ MY COMMISSION#HH 117153
[ ] Personally Known OR [ /Produced Identification
��. = EXPIR5S:Apr1113,2025
�rFOFF;q •- NotaryBonded Thru UnderPublic ers Type of Identification: - 0 - L -
Updated 10/17/18