475 Whiting Ln PLRS23-0059 Permit `li PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
JS j 1
CITY OF ATLANTIC BEACH PLRS23-0059
800 SEMINOLE ROAD ISSUED: 4/13/2023
Dili,, ATLANTIC BEACH. FL 32233 EXPIRES: 10/10/2023
MUST CALL INSPECTION • 914 • • PM FOR NEXT DAYINSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • '
CODE, ' OF ' CH 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:
475 WHITING LN PLUMBING RESIDENTIAL REPAIR PVC BRANCH UNDER $800.00
SLAB
TYPE OF
ZONING: :D •
• • GROUP:
171434 0000 ROYAL PALMS UNIT
02A3.00
COMPANY: ADDRESS: CITY: STATE: ZIP:
HOLLINGSWORTH
PLUMBING COMPANY 8242 CIRCLE STS JACKSONVILLE FL 32216
•� 111pil q111111111111
1111 C11!11 CITY: STATE: ZIP:
DAYE DOUGLAS H 475 WHITING LN ATLANTIC BEACH FL 32233-3912
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 • •
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 0 $0.00
PLUMBING FIXTURES 455-0000-322-1000 1 $7.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
Issued Date:4/13/2023 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 PLR
�
`'r Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT pLRSz3-OcSc
JOB ADDRESS: 7 Q iohl L Y, PROJECT VALUE $ ;800
❑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
XMISCELLANEOUS
F Sewer Replacement
ii Back Flow Preventer
I Lawn Sprinkler System (number of sprinkler heads)
Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
i Well **SJRR�WD Well Completion Form.Completed form to be submitted/to the Building Department for final inspection. **
jri Other ,Ccs,,;, t ni+
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: Office Phone: !gLjy-$91-9`/36 Fax
J k yJI e
Co. Address: $a yon C�'�c1e 5� , City: A&6WjhLjgqA State: Zip: Sao?i G
License Holder: State Certification/Registration# /y3/57 7
Notarized Signature of License older ''�--
The forego' instrument�as acknowledged before me this f r 20 the State of Florida,
County of �a
.......... TOtrIGINDLESPERGER Signature of Notary Public
PAY COMMISSION#GG 353178
EXPIRES:OctP JjcU2023 [ ] Personally Known OR [ ] Produced Identification
''•'.fio'Fe�°Q Bonded 7hn Notary Public Underwrllers
Type of Identification: (v,
Updated 10/17/18