411 WHITING LN PLRS23-0153 C ' . PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
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1CITY OF ATLANTIC BEACH PLRS23-0153
800 SEMINOLE ROAD ISSUED: 8/24/2023
�°'3i9Y.,%l ATLANTIC BEACH. FL 32233 EXPIRES: 2/20/2024
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:
411 WHITING LN PLUMBING RESIDENTIAL INTERIOR CAST IRON $6000.00
REPLACEMENT - 6 FIXTURES
TYPE OF REAL ESTATE BUILDING USE
ZONING: SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171442 0000 ROYAL PALMS UNIT
02A3.00
COMPANY: ADDRESS: CITY: STATE: ZIP:
EMERGENCY REPAIR 1195 WHISPERING PINES RD JACKSONVILLE FL 32259
PLUMBING INC
OWNER: ADDRESS: CITY: STATE: ZIP:
JONES AZII 3622 CORAL WAY #1307 MIAMI FL 33145
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 $2.00
Issued Date:8/24/2023 1 of 2
rA,�,r Plumbing Permit Application **ALL INFORMATION
J,' HIGHLIGHTED IN
'13 City of Atlantic Beach Building Department GRAY IS REQUIRED.
r�
�" 800 Seminole Rd, Atlantic Beach, FL 32233 `7 C
--�uit19.' Phone: (904) 247-58261,13n#2
Email: Building-Dept@coab.us PERMIT#: �� 23-0 t J:
JOB ADDRESS: 411 1f.��;�i fl� LQ fe PROJECT VALUE$ Lo `n00.9-e?
NEW OR REPLACEMENT INSTALLATION and/or EIRE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 1 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 5., Water Heater
Other Fixtures Water Treating System
❑MISCELLANEOUS ,
❑ Sewer Replacement C a-4 1 I'O(\ 111 kOC)\-
0
Back Flow Preventer O(N ( 1 _
❑ 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.**
ii Other
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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:A-z�z� l.k)Yr9 S 000)211'3i
Phone Number:
Plumbing Company: �YY1P�('C�f Y1CA �V(Alk ffice ne:goy-ol j - )/„ Fax PIA
Co. Address: VAS \\1Y1\Sp�C V\q Pkr*S &City: S\. ,- dAY\S State: cL, Zip: 3;; c
License Holder: C5ELA C7• G O cc State Certification/Registration #0_,V C n 73 I
Notarized Signature of License Holderg'_ �.114,0•,r
INIA
The forego' nstrumen as acknowledged before me this (.._Liday of41_T, 2023n the State of Florida,
County of 1,_____) 04-C1/4.—\
1111 111111
Signature of Notary Public • �_
S;YF •. TONT GINDLESPERGER I ] Personally Known OR [ ] Produced Identification 4
=o
MY COMMISSION#GG 353178 Type of Identification: 'T,l--
"'• •. EXPIRES:October 6,2023
:� .oma.,.
OF.f°, Bonded Thru Notary Public Underwriters Updated 10/17/18