1777 W Park Terrace PLRS23-0110 Permit PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
s PLRS23-0110
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ISSUED: 6/20/2023
ATLANTIC BEACH, FL 32233 EXPIRES: 12/17/2023
CODE,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
' OF BEACH CODEOF ORDINANCES .
ALL CONDITIONS OF PERMIT r r 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:
1777 W PARK TER PLUMBING RESIDENTIAL PLUMBING - 15 FIXTURES $9500.00
ADDITION
TYPE OF r
• • GROUP:
172020 0382 SELVA MARINA UNIT 08
■ • err • �■
STYLES SMITH PLUMBING 1537 PENMAN RD SUITE A JACKSONVILLE FL 32250
BEACH
•
ADDRESS: CITY: STATE: ZIP:
OUELLETTE ROBERT C 1777 PARK TER W ATLANTIC BEACH FL 32233-5611
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 4SS-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 15 $105.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.40
STATE DCA SURCHARGE 4S5-0000-208-0600 0 $2.00
TOTAL:$164.40
Issued Date: 6/20/2023 1 of 2
Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
r
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 Licsz3- D ( o
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMITT#: Re- i ;t;�" ODS
JOB ADDRESS: ) 7 7 7 I,/ &fX 7-C' PROJECT VALUE $ "I, ✓`rbc 00
E2NEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer I Shower l
Dishwasher I Shower Pan I
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet oL
Hose Bibs d. Urinal
Kitchen Sink I Vacuum Breakers a-
Laundry Tray \ Water Connected Appliances
Lavatory 3 '\Water Heater 1
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. **
Li 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: f4 0 0 V e,11 eJ'e- Phone Number:
Plumbing Company: lP)✓Mb)'^8 �GOffice Phone: 1014 -81 -q6) Fax
Co. Address: )537 Pelov� rd- City: J kx 5,e G,64n State:fLZip:
License Holder: 5 Vl f_'2 5M i 1-, State Certification/Registration #Gi=(, )K ;�iO 5d2
Notarized Signature of License Holder 2::
�
The foreg°+ strument was acknowledged before me this da �!l 21�� n the State of Florida,
County of b—J u V)
c: TO'`,
" Signature of Notary Public
•' *, �rsonall Known OR Produced Identification
=°s• o EXPIRES: . 6,X823 Y
' Type of Identification:
�FF�. Bcnded l'nru Nc iy cU^derwdters
Updated 10/17/18