1900 Seminole Rd PLRS23-0165 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
WOOTEN DANIEL
MATTHEW 1900 SEMINOLE RD ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
169527 0010 SECTION LAND
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
1900 SEMINOLE RD PLUMBING RESIDENTIAL PLUMBING - ONE FIXTURE $1000.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 1 $7.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $66.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
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.
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.
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.
1 of 1Issued Date: 9/21/2023
PERMIT NUMBER
PLRS23-0165
ISSUED: 9/21/2023
EXPIRES: 3/19/2024
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
Plumbing Permit Application ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
1 800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 1,3 (--1S-23 b16 5
JOB ADDRESS: 1900 Seminole Rd.,Atlantic Beach, FL 32233 PROJECT VALUE $ 1,000.00
dVEW 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 1 Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
LJVIISCELLANEOUS
Sewer Replacement
DBack Flow Preventer
El 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 Plumbing for Outdoor Kitchen and Outdoor Shower
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: Daniel Wooten Phone Number: (352)219-5601
Plumbing Company: N/A Office Phone: Fax
Co. Address: i 74 Q Ste:n*IC Rd City: 14/e..,ic. 13ta,t, State:a Zip: ?22 33
License Holder:
LL
State Certification/Registration #
Notarized Signature of License Holder dL7
Al- '
The foreg instrume was acknowledged before me this? ( day of (3V4 , 200 in the State of Florida,
County of Ut(C`.
Signature of Notary Public L ' ._.____..
i`o,• •. TONI GINDLESPERGER PersonallyKnown OR Produced Identification
A= :•_ MYGOMMISSIUN#GG 353178 Type of Identification: LN• ....= EXPIRES:October 6,2023
fir ,-
Fi),'I Bonded Thru Notary Public Underwriters Updated 10/17/18
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