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1636 ATLANTIC BEACH DR PLRS22-0044 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP: WILKES GREGG 1636 ATLANTIC BEACH DR ATLANTIC BEACH FL 32233- COMPANY:ADDRESS:CITY:STATE:ZIP: Superior Plumbing 8235 Dickie Drive Jacksonville FL 32216 TYPE OF CONSTRUCTION: REAL ESTATE NUMBER:ZONING:BUILDING USE GROUP:SUBDIVISION: 169505 1110 ATLANTIC BEACH COUNTRY CLUB UNIT 01 JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK: 1636 ATLANTIC BEACH DR PLUMBING RESIDENTIAL SHOWER PAN FOR CHANGING TUB TO SHOWER $2000.00 FEES DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT PLUMBING BASE FEE 455-0000-322-1000 0 $55.00 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: $66.00 LIST OF CONDITIONS Roll off container company must be on City approved list . Container cannot be placed on City right-of-way. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management districts, state agencies, or federal agencies. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION. ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA BUILDING CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES . ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY. 1 of 2Issued Date: 3/24/2022 PERMIT NUMBER PLRS22-0044 ISSUED: 3/24/2022 EXPIRES: 9/20/2022 PLUMBING RESIDENTIAL PERMIT CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 2 of 2Issued Date: 3/24/2022 PERMIT NUMBER PLRS22-0044 ISSUED: 3/24/2022 EXPIRES: 9/20/2022 PLUMBING RESIDENTIAL PERMIT CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 w 4YCity of Atlantic Beach Building Department ALL INFORMATION 800 Seminole Road, Atlantic Beach, FL 32233 HIGHLIGHTED IN GRAY Phone: (904) 247-5826 Email: Building-Dept@coai } IS REQUIRED. s. Job Address: ICI 3 ti: ki t44M i"I C R?a b(i 1H, Permit Number: -SZ Z —OC), 7 Legal Description La+- 15`+, iktl ii . 3,,,,,h. 6c4tt(To (..k. ,JA 4 I RE# I Lt1 S"dr_ I 1 10 Valuation of Work(Replacement Cost)$ 4, COO . " Heated/Cooled SF Non-Heated/Cooled Class of Work: New Addition Alteration ®Repair DMove Demo Pool Window/Door Use of existing/proposed structure(s): Commercial EfResidential If an existing structure, is a fire sprinkler system installed?: DYes DNo Will trees) be removed in association with proposed proiect? DYes(must submit separate Tree Removal Permit) & No Describe in detail the type of work to be performed: /;;:‘ I: i w;..-c. •j,1,1,.,,,..q... 1,/r4.,1 r L`YlL.A. f iii.5 fu..i( iltc,+. r t I t, • Lb .-f-10 V©c),D Florida Product Approval# for multiple products use product approval form Property Owner information Name &INt- I1$)i I Ic4 S.J 1 it 3. //J.'k c Address Ito 3t.' A-1-i. (t'I'7 c- (,?{a.c. ._ 0 i'i u - N t vCity1-1-4-6.0.41 L.. 11[G cJ'l/ State Fl. Zip - ,A-2-33 Phone +fes -10.1- g b's13 E-Mail Si-1.IKCS ISG ti c ( .C_4 +-1''t Owner or Agent(If Agent, Power of Attorney or Agency Letter Required) Contractor Information Name of Company SC& IC,CtI ?<Ski,l+"C01Str14-+-l". LAG Qualifying Agent 1.-16& ptWKe' Address 1 i I t3i'ac, R-VivL City tlfIa.vt`ha, g[ac State FL.. Zip 1 Office Phone C 04 - S 2. I - I-1-?5--7 Job Site Contact Number 104 - 025--SDC` State Certification/Registration# C C- 11C-3,1 lbE-Mail >C'G:ltJtl ii.,' 104)64. 9rnai i . cm' Architect Name&Phone# Engineer's Name&Phone# Workers Compensation Insurer OR Exempt Expiration Date 5 I r 120 :a. Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all the laws regulating construction in this jurisdiction.I understand that a separate permit must be secured for ELECTRICAL WORK,PLUMBING,SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS,TANKS,and AIR CONDITIONERS,etc. 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. OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECOR , NG YOUR NQT C OF COMMENCEMENT. f' r f... ,f L.d1---. tib Signature of Owner or Agent) Signature of Contrarct ) Signed and sworn to(or affirmed) before me this?30 day of Signed and sworn to(or affirmed)before me this I 1 day of i.:ti .'7 , , crr), ,by )vS/' I,4J;IA c SVOAU(tirt,i ,_i-ti :L , by I.\CI tit i LC t.1 Signatur 4f Notary) Signaturesof otary) S i •:. ZACHARY KAHALY CAROLINE J.SCHROEPFER personally Known OR Notary Public State of Florida [ ] Personally Known OR Commission N GG 366355Commission#GG 924046IlProducedIdentification77 roduced Identification o J ExplreSAugust 15,2023MyComm.Expires Oct 20,2023 Eof Bonded T Troy Fain Insurance 900.395.7019BondedthroughNationalNotaryAssn. By Mike Jones at 1:44 pm, Mar 08, 2022 REVIEWED FOR CODE COMPLIANCE DESCRIPTION ACCOUNT QTY PAID PermitTRAK $66.00 PLRS22-0044 Address: 1636 ATLANTIC BEACH DR APN: 169505 1110 $66.00 PLUMBING $62.00 PLUMBING BASE FEE 455-0000-322-1000 0 $55.00 PLUMBING FIXTURES 455-0000-322-1000 1 $7.00 STATE SURCHARGES $4.00 STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00 STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00 TOTAL FEES PAID BY RECEIPT: R19103 $66.00 Printed: Thursday, March 24, 2022 10:50 AM Date Paid: Thursday, March 24, 2022 Paid By: LISA PELKY Pay Method: CREDIT CARD 611873428 1 of 1 Cashier: TG Cash Register Receipt City of Atlantic Beach Receipt Number R19103