42 3rd St PLRS22-0139 45m7p., PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
0 CITY OF ATLANTIC BEACH PLRS22-0139
800 SEMINOLE ROAD ISSUED: 9/20/2022
,r�; EXPIRES: 3/19/2023
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: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
42 3RD ST PLUMBING RESIDENTIAL PLUMBING - REPIPE 6
FIXTURES $1200.00
TYPE OF REAL ESTATE BUILDING USE
ZONING: SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170193 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
STYLES SMITH PLUMBING 1537 PENMAN RD SUITE A JACKSONVILLE FL 32250
BEACH
OWNER: ADDRESS: CITY: STATE: ZIP:
KENNETH BROWN 42 3RD ST ATLANTIC BEACH FL 32233
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 6 $42.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$101.00
Issued Date:9/20/2022 1 of 2
Plumbing Permit Application **ALL INFORMATION
�� HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 P LJZZ.-0I 39
F
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: E 5P-2--0/670
JOB ADDRESS: a TPROJECT VALUE$ 1, 20o.oo
ElNEW OR REPLACEMENT INSTALLATION and/or El RE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower 2-
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 1-
Hose
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray L Water Connected Appliances
Lavatory 'L Water Heater
Other Fixtures Water Treating System
LI MISCELLANEOUS /)
u Sewer Replacement
O Back Flow Preventer
O Lawn Sprinkler System (number of sprinkler ds)
❑ 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 aelod V./ dr.,j^ /Pot/ e/d R 2
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: Phone Number:
Plumbing Company: 5)y/e9 SM r t) Plvrlh �✓G• Office Phone: —,41//-40/ Fax
Co. Address: 1537 )7'/'7M lc/ City: TAX 13e4.c i State:/G Zip: 3.-,AS6
License Holder: 5}if1P,5 5"111 1-1 State Certification/Registration # CPC
Notarized Signature of License Holder •
The foregoinstrument 7s acknowledged before me this ? . if O 20Z- 7trtthe State of Florida,
County of
Signature of Notary Public ,
r TONI GINDLESPERGER
MY COMMISSION#GG 353178 ersonally Known OR [, Produced Identification
EXPIRES:October 6,2023 Type of Identification: .
1?,‘'‘ Bonded Thru Notary Public Underwriters
Updated 10/17/18