1855 BEACH AVE PLRS23-0139 - !--,V./: ''' ,iErim
PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
's.Ot
f•jCITY OF ATLANTIC BEACH PLRS23-0139
~o ISSUED: 8/2/2023
\ 800 SEMINOLE ROAD
\on p_ ATLANTIC BEACH, FL 32233 EXPIRES: 1/29/2024
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:
1855 BEACH AVE I PLUMBING RESIDENTIAL PLUMBING - 8 FIXTURES $0.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: i NUMBER: GROUP:
169723 1115 THE NAUTILUS
CONDOMINIUM
COMPANY: ADDRESS: CITY: . STATE: ZIP:
STYLES SMITH PLUMBING 1537 PENMAN RD SUITE A JACKSONVILLE FL 32250
BEACH
OWNER: ADDRESS: CITY: i STATE: ZIP:
MATHEWS DONNA 3292 FM 1699 i AVERY TX 75554
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 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 8I $56.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$115.00
Issued Date:8/2/2023 1 of 2
s•mr Plumbing Permit Application **ALL INFORMATION
s �� HIGHLIGHTED IN
�° City of Atlantic Beach Building Department GRAY IS REQUIRED.
�.- 800 Seminole Rd, Atlantic Beach, FL 32233 'J
`'`'~ _ Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: Re 5 23` 4/cO
JOB ADDRESS: /355 / 4-tC L► 4ve.„. PROJECT VALUE 002 i COG-co
T4 EW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub I Septic Tank & Pit
Clothes Washer Shower 1
Dishwasher Shower Pan I
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 2
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory —3 Water Heater
Other Fixtures Wat r Treating System
❑MISCELLANEOUS CO
El Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler hea
E Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
E Well **SJRWD Well Completion Form.Completed form to be submitted to the Building Department for final inspection. **
❑ Other Remodel arY ex�5i-;4 -n x}vje 5
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.
I hereby certify that I have read this application and know the same to be true and correct. All provisions of laws and ordinances
governing this work will be complied with whether specified or not. The permit does not give authority to violate the provisions
of any other state or local law regulation construction or the performance of construction.
Owner Name: 170,n/1 P. ni-Mi f, J 5 Phone Number:
Plumbing Company: S})I e 9 z'.i ,' ii Piv^yyji'.�F, Z"Office Phone: 'jac( "c211/ '1//3/ Fax
Co. Address: 1.537 Pe4Avvi fcl. City: JG.X 13-eti 61-7 State:FL.Zip: 3 ,2-.5-Dlicense Holder: j)'e 5 5/1,114
State Certification/Registration # CF-C,,. I i(2.$&V-
Notarized Signature of License Holder ---,,f5/-\ L--
._
The foreg instrument as acknowledged before me this -a day of ' 20zin the State of Florida,
County of C� ,
Signature of Notary Public _A
Ed...4" ."Ibni''''''64!;`Rk., TON rNDL_.SPERGER -tersonally Known OR [ ] Produced Identification 4
t "' = MY COMMISSION#GG 353178
'" '' Type of Identification:
-.: �s EXPIRES:October 6,2023
of F�qP. Updated 10/17/18
��.,,,,.,` Bonded Thru Notary Public Underwriters