95 10th St PLRS22-0064 Plumb Permit s�;+`mi,:,} PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
"' PLRS22-0064
r =A_ CITY OF ATLANTIC BEACH
JVD 800 SEMINOLE ROAD ISSUED: 5/2/2022
4C,319'" EXPIRES: 10/29/2022
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: I PERMIT TYPE: I DESCRIPTION: I VALUE OF WORK:
' 95 10TH ST PLUMBING RESIDENTIAL RE-PIPE 12 FIXTURES $4600.00
ZONING: . GROUP: SUBDIVISION:
TYPE.OF REAL'ESTATE $UILDIN=G USE
CONSTRUCTION: NUMBER;.
170263 0010 � ATLANTIC BEACH
COMPANY: ! ADDRESS: I CITY: r STATE: ! ZIP:
STEEG PLUMBING 1601 MAIN STREET , ATLANTIC BEACH FL 32233
COMPANY INC
OWNER: ADDRESS: CITY: , STATE: I ZIP:
LANIER KAY S ET AL 95 10TH ST ATLANTIC BEACH FL 32233-5701;
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 1 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 12 $84.00
STATE DBPR SURCHARGE 455-0000-208-0700 J 0 $2.09
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$143.09
Issued Date:5/2/2022 1 of 2
s'=+,`rr Plumbing Permit Application **ALL INFORMATION
j
-> '=' HIGHLIGHTED IN
'J City of Atlantic Beach Building DepartmentGRAY IS REQUIRED.
_ 800 Seminole Rd, Atlantic Beach, FL 32233
� ,31110 € L RS2 z-cob 4-
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 71 /D 1 PROJECT VALUE$ 40-Ai
❑NEW OR REPLACEMENT INSTALLATION and/or RE-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 c__-9F Water Heater /
Other Fixtures Water Treating System
❑MISCELLANEOUS
❑ Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sp -• - eads)
❑ 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.**
O 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: 11, - .-, '> ; — Ket_ otiverd Phone Number: RI° f�S'0f
Plumbing Company: c5), M 6 Mc. Office Phone: Z7,-e57g11 Fax
Co. Address: /611 , iii /*--- City: 111-- G) State / Zip: . .3
License Holder: /7/ ( State Certification/Registration# efeQ37f/1:7
f G
Notarized Signature of License Holder 1�//y /��
The foregoir} ' trument was a knowledg: before me this a •.y • 1, a _ , 202-, he State of Florida,
County of L2U
Signature of Notary Public _—� _
_
ftp,' ''', TONI GINDLESPERGERM '
'_ ,_. = MY COMMISSION#GG353178 {J..P-ersonally Known OR [ 1 Produced Identification
` " Type of Identification:
t� r`�,.:o EXPIRES;October 6,2023
�' '''`i,'F'F;°P� Bonded Thru Notary Public Underwriters Updated 10/17/18