488 SKATE RD PLRS22-0040 i
PLUMBING RESIDENTIAL PERMITPERMIT NUMBER
r sem
si CITY OF ATLANTIC BEACH PLRS22-0040
x ISSUED:SEMINOLE ROAD 3/21/2022
"—asl 9� ATLANTIC BEACH. FL 32233 EXPIRES: 9/17/2022
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:
488 SKATE RD PLUMBING RESIDENTIAL PLUMBING - 2 FIXTURES $680.00
TYPE OF REAL ESTATE ZONING: BUILDING USE I SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171567 0000 ROYAL PALMS UNIT
02A3.00
COMPANY: ADDRESS: CITY: STATE: ZIP:
ADVANTAGE PLUMBING 880 MAYPORT RD JACKSONVILLE FL 32240
BEACH
OWNER: ADDRESS: CITY: STATE: ZIP:
WILEY ADELL N 488 SKATE RD ATLANTIC BEACH FL 32233-3822
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 455-0000-322-1000 0 $55 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: 3/21/2022 1 of 2
t'"r, Plumbing Permit Application "ALL INFORMATION
�' HiGHLtGHTED IN
?u City of Atlantic Beach Building Department
A
GRAY 6REQUIRED.
yT 800 Seminole Rd, Atlantic Beach, FL 32233 PL R 2Z-_0O1
';.:...". 5"1
—" Phone: (904) 247-5826 Email: Building-Dept@coab.us a
JOB ADDRESS: 1 0(8 (Sk4 r& k,o.40PROJECT VALUES (,?e,,..0.--.
Eyit OR REPLACEMENT INSTALLATION and/or DIE-PIPE
TYPE OF FIXTURE
QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower —+----
Dishwasher Shower Pan --L_____
Drinking Fountain - S op Sink
Floor Drain Three Compartment Sink
loorSink Toilet
_
Hose BibsUrinal
kitchen Sink. Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
s MISCELLANEOUS
OSewer Replacement
,,::Bark Flow Preventer
Dawn Sprinkler System (number of sprinkler heads)
:grease interceptor (Trap}_ gallons(Requires 3 sets of plans)
C Well •'j1Rwp Wel:Comp)P11017 Form.Completed form to e submitted to the 94,ilding artrient for fina'tr4pecfon_"
:Other
er! it becomes void if work does not commence within a six month period or work s suspended or abandoned for six months.
hereby certify that I have read this application and know the same to be true and rorrect. All provisions of rows and aroinancjes
governing this work will be complier( w4h %I tether specified or not. The permit does not Rive authonty to viciate the provisions
of any other:tate or local lawrepu'at'o't constructun rthe performance of construction.
Owner Name; ADae 0L(, `( Phone Number: 50- i 2_
Plumbing Company:Wc�vci,,\-k-cLc t,�UvA�ui c,G Office Phonec1®LI 2�k 1 �^t c.`(S rax
Co.Address: eig O V\Act-t o •
LIP r t a of Ci.,y, �'i b State:] . Zip: ? z 3
License Holder:Zia 41 g / ti, L 4 6' ,State C (cation/Registration# efri 44--C-Y,5--7
Notarized Signoture of License Holder X' X\ " '
si4Te
The foregoing instrument was acknowledged before me this day of , 20in the State of Florida,
Courts of
— — e - Signature of Notary Public; v '1r,(.PAA_
1 Notary Public State of Florida 1
4 Stacy Sanders
4 My Commission [ Personally Known OR ; ; Produced identif caatior'
�u HH 182982
1 Exp. 10n/2025 1 Type of ldentificat,on:
:4/00pe11.2147/2E