785 Sailfish Dr PLRS22-0089 Plumbing Permit 444,_LL'�'�`.{ `
f"''`� PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
Sly
CITY OF ATLANTIC BEACH PLRS22-0089
ISSUED: 6/15/2022
800 SEMINOLE ROAD
ATLANTIC BEACH. FL 32233 EXPIRES: 12/12/2022
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,IPIVIC, 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: I DESCRIPTION: VALUE OF WORK:
785 SAILFISH DR PLUMBING RESIDENTIAL PLUMBING 3 FIXTURES & $2500.00
SEWER REPLACEMENT
TYPEREAL ESTATE BUILDING USE
OF ZONING: SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171239 0000 ROYAL PALMS UNIT 01
COMPANY ADDRESS: CITY: STATE: ZIP:
AFFORDABLE PLUMBING 4545 ST AUGUSTINE RD JACKSONVILLE FL 32257
COMPANY OF
OWNER: �' ADDRESS: I CITY:. I STATE: I ZIP:
LEPINE ANTHONY ALBERT 785 SAILFISH DR ATLANTIC BEACH FL 32233-4214
ET AL
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.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 4 $28.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
Issued Date:6/15/2022 1 of 2
'"nit
Plumbing Permit Application **ALL INFORMATION HIGHLIGHTED IN
;any;._ City of Atlantic Beach Building Department GRAY IS REQUIRED.
\ � 800 Seminole Rd, Atlantic Beach, FL 32233 PL.:Rs - } CSO o'
Phone: - 1S a- ? ^Of3
(904) 247 58 6 Email: Building-Dept@coab.us PERMIT T �
R I #.
JOB ADDRESS: v6 U 8(4V . --(Ch a/aPROJECT VALUE$ 62 CO 07
E l 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 I
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet _li
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory ( Water Heater
Other Fixtures Water Treating System
❑MISCELLANEOUS
ti 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: L9-y I Y- -k( ti -Cao 'j V `� Q c Phone Number: `n Som(
S s9 Z
vbcePh ( FQ6 �8Plumbing Company: (A"(P0rAc-ole- V(UVAo ice one: tVr- Fax 1 `' b5 _
Co.
Address: `"\C(0� 11-001) +1M, a City:JPjy' Stat« Zip: -- 2
License Holder: 6(/) 2A/1T S - CoLo5Na tate Ce ifica o /Registration # CV Co51 ZZ U
Notarized Signature of License Holder ovi4 742'U`"L‘
The foreg•in • strumen was acknowledged before m this IS day c _ * , 207K in the State of Florida,
County of�('Af r✓
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,,. =..._ -sem , Signature of Notary Public - a_._ '1/44L-----z...7
._„0,;;:c ,,, TONI GINDLESPERGER
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-k:' fir •,_ MYCOMMISSION#GG 353178 i,t [ ] P rally Known OR [ ] Produced Identification
: I' Type of Identification:
�`FOc..,:°_ .^ c•;7hru�o'.�rtr Fuhi;c U,;•�.;,.;liars
s. ..u_ .�.•a.._ Updated 10/17/18