309 Plaza PLRS23-0200 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
STEVEN AND REBECCA
GOLDWASSER REVOCABLE
TRUST
8483 STABLES RD JACKSONVILLE fl 32256
COMPANY:ADDRESS:CITY:STATE:ZIP:
DUVAL CONSTRUCTION
INC 13221 Mendenhall Pl JACKSONVILLE FL 32224
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
169990 0000 ATLANTIC BEACH
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
309 PLAZA PLUMBING RESIDENTIAL GUEST HOUSE - 9 FIXTURES $2500.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 9 $63.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
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 2Issued Date: 11/30/2023
PERMIT NUMBER
PLRS23-0200
ISSUED: 11/30/2023
EXPIRES: 5/28/2024
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
TOTAL: $122.00
2 of 2Issued Date: 11/30/2023
PERMIT NUMBER
PLRS23-0200
ISSUED: 11/30/2023
EXPIRES: 5/28/2024
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
Plumbing Permit Application ALL INFORMATION
HIGHLIGHTED INri
City of Atlantic Beach Building Department GRAY IS REQUIRED.
3 800 Seminole Rd, Atlantic Beach, FL 32233 FLT`S 2 5 - ,z_C(--)
c,-„,'` Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:// 2 -6092,
JOB ADDRESS: _ 9# P/%r/j
PROJECT VALUE $ 20(70'
El NEW OR REPLACEMENT INSTALLATION and/or ill RE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer Shower i
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet g_
Hose Bibs h Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater I
Other Fixtures Water Treating System
MISCELLANEOUS cAi. ‘
C Sewer Replacement7
C Back Flow Preventer
C: Lawn Sprinkler System (number of sprinkler heads)
C Grease Interceptor (Trap) gallons (Requires 1 set of digital plans)
C Well **SJRWD Well Completion Form.Completed form to be submitted to the Building Department for final inspection. **
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:rbA t' 6 d G1 S5-Cle Phone Number: /01-233-406267
Plumbing Company: 0!/0 liitff-S-/P-i-- 7011 /fiC' Office Phone: 90P-8ig71.p31 Fax
Co. Address:/92I L -, Y P2- City: YVV State: /2 Zip: 3Z222
License Holder: '-.1)/11(24, State .-rt.fication/Registration #
Notarized Signature of License Holde d00,
The foregoingynstrumentiwas acknowledged before me this :?J( 'day o ''N.,\ • , 206—,--ki the State of Florida,
County of .1 ( c
114
Signature of NotaryPublic
TONI
GINDLESPERGER g
I, MY COMMISSION#111-1407122
EXPIRES..October 6,2027 LI-Personally Known OR [ ] Produced Identificati•n
Type of Identification:
Updated 10/11/23