1628 Beach Ave PLRS22-0158 Permit PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS22-0158
9 " ISSUED: 10/20/2022
iL v� 800 SEMINOLE ROAD EXPIRES:4/18/2023
ATLANTIC BEACH. FL 32233
INSPECTIONMUST CALL • (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL VVIRK NlYST CINFIRM • THE CYRRIENT iTH ETITI1;J1 • • • • • 91JILIWG
CODE, NEC, IPIMC, 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:
1628 BEACH AVE PLUMBING RESIDENTIAL PLUMBING -SHOWER PAN $750.00
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169548 0000 OCEAN GROVE UNIT 01
COMPANY: ADDRESS:
TOG PLUMBING 4426 LOYS DR JACKSONVILLE FL 32246
ADDRESS: CITY: STATE: ZIP:
SCHWAB KIMBERLY K 996 STOCKS 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 4550000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000322-1000 1 $7,00
STATE DBPR SURCHARGE 455-0000-208-0200 0 $2.00
STATE DCA SURCHARGE 455-0000-208-06M 0 $2.00
TOTAL:$66.00
Issued Date:10/20/2022 1 of 2
Plumbing Permit Application '*ALL INFORMATION
� HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
I /J 800 Seminole Rd, Atlantic Beach, FL 32233 I R
Phone: (9040T)�247-5826 Email: Building-DeptiMcoab.us PERMIT M:P" `SZZ- Ns
JOB ADDRESS 6�95 SJ,PAO\ A JLC, PROJECT VALUE$ Y � S� 6
El 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
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
LaundryTray 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:-�yto,\"^QJ S GNW+Q Phone Number:
Plumbing Company�� Office Phone: �Lh- 7��1I Fax
Co.Address:t-(y�-L �C1C1�S QY(L- City: State:_Zip;
License Hold F::[�A �A 'tee`'( S ate Certification/Registration Jt C-F C 14 2`�Oi LZ
Notarized Signature of License Holder ^\--�—
The forego: ' trument was acknowledged before me this 2na 202 the State of Florida,
County of 1�
Signature of Notary Public
+'.° TOJI GINDLESFcR^FR
" Personally Known OR [ ] Produced Identification
MY COMMISSIONS GG 3a317B
EXPIRES:Ceober 6,2023 Type of Identification:
•'�.Bonaea iDm N.,Pubic Dlelr ams Updated 10/17/18