950 Seminole Rd PLRS22-0092 **ALL INFORMATION
Plumbing Permit Application HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
J 800 Seminole Rd, Atlantic Beach, FL 32233fL 5 2 Z_00
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
PROJECT VALUE $ �-4V
JOB ADDRESS: 7�N?�ry�G
NEW OR REPLACEMENT INSTALLATION and/or EIRE-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
Other Fixtures Water Treating System
❑MISCELLANEOUS
❑ Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler heads)
❑ 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. **
❑ 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: •1 A, Phone Phone Number:
Plumbing Company: Gam' / C hC Office Phone: 21 1`/-" j V Fax
Co. Address: /�(�/� Jl _ City: Aw- JQ State:EL Zip:
License Holder: ie& State Certification/Registration #
r
Notarized Signature of License Holder
The foregoing instrument was acknowled before me s day of JjA n e , 20`x , in the State of Florida,
County of w✓�
Signature of Notary Public
;yY► r
JENNIFER JOHNSTON [��ersonally Known OR [ ] Produced Identification
MY COMMISSION#HH 051519 Type of Identification:
o EXPIRES:october 21,2024 Updated 10/17/18
is°`' Bonded T,"Notary Public Undenrri'M
PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
PLRS22-0092
CITY OF ATLANTIC BEACH ISSUED: 6/23/2022
800 SEMINOLE ROAD
ATLANTIC BEACH. FL 32233 EXPIRES: 12/20/2022
MUST CALL INSPECTION • • (9 04) : BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT6TH EDITION1 OF • '
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT • . PLEASE
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.
• : . •N: VALUE OF •
950 SEMINOLE RD PLUMBING RESIDENTIAL 3 fixtures $600.00
TYPE OFREALESTATE BUILDING USESUBDIVISION:
•
• • GROUP:
171972 0000 SELVA MARINA UNIT 03
ADDRESS:
STEEG PLUMBING 1601 MAIN STREET ATLANTIC BEACH FL 32233
COMPANY INC
• ADDRESS:
HOWELL SHIRLEY B 950 SEMINOLE RD ATLANTIC BEACH FL 32233-5456
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.
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 3 $21.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$80.00
Issued Date:6/23/2022 1 of 2