1058 Beach Ave PLRS22-0016 Priv Pro Plumb , `ir-24% PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS22-0016
t4 800 SEMINOLE ROAD ISSUED: 2/4/2022
;.>, 7 EXPIRES: 8/3/2022
ATLANTIC BEACH, FL 32233
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:
1058 BEACH AVE PLUMBING RESIDENTIAL PRIVATE PROVIDER $1500.00
PLUMBING 6 FIXTURES
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170259 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
STYLES SMITH PLUMBING 1537 PENMAN RD SUITE A JACKSONVILLE FL 32250
BEACH
OWNER: ADDRESS: CITY: STATE: ZIP:
HIONIDES CHRIS PO BOX 330108 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.
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 6 $42.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2 00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2 00
TOTAL:$101.00
Issued Date:2/4/2022 1 of 2
,, ,', PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
F i.,:J PLRS22-0016
,j CITY OF ATLANTIC BEACH
��� 800 SEMINOLE ROAD ISSUED: 2/4/2022
,� EXPIRES: 8/3/2022
ATLANTIC BEACH, FL 32233
Issued Date:2/4/2022 2 of 2
Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
s City of Atlantic Beach Building Department GRAY IS REQUIRED.
NNW 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: `D 5E5 /3eAGL+ A/C_ PROJECT VALUE $ li 944. 04
LIEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower Z
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet .Z
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory oZ Water Heater 1-
Other
Other Fixtures Water Treating System
❑MISCELLANEOUS
❑ Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkle
❑ 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. **
n Other Al2d'ino {7`5.71/-✓y d00/4 :1
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: `� 10 d es Phone Number:
Plumbing Company:51y/e.5 5Alit'' 12 l ii.1y t'i LN"rice Phone:qDy-a1//-,118 / Fax
Co. Address: L.9-3 ?e,lMan f d. City: :14,X Retie/' State: FL Zip: 3225-0
License Holder: 575/e.5 5r1, fI State Certification/Registration # C__ 6/112g6S,2
Notarized Signature of License Holder
7
The foregoing i trent was ac nowledged before me this 41 day of , 22�iwthe State of Florida,
County of s--1 ID\f ct
Signature of Notary Public
[ ] Personally Known OR [ ] Produced Identification
TONI GINDLESPERGER Type of Identification:
• •* MY COMMISSION#GG 353176
EXPIRES:October 6,2023 Updated 10/17/18
"'$ '14,1`P'‘,1 '‘ BondedThr
Med u Notary Public Underwriters
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