831 Bonita Rd PLRS23-0204 COAB Permit Form with ConditionsOWNER:ADDRESS:CITY:STATE:ZIP:
HAMMERSCHMIDT
BRENDA 2144 67TH ST E INVER GROVE
HEIGHTS MN 55077
COMPANY:ADDRESS:CITY:STATE:ZIP:
Elite Plumbing Contractors
LLC 54646 Wildlife Way Callahan FL 32011
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171152 0000 ROYAL PALMS UNIT 01
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
831 BONITA RD PLUMBING RESIDENTIAL 16 Fixtures $15000.00
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 16 $112.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.51
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $171.51
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: 12/14/2023
PERMIT NUMBER
PLRS23-0204
ISSUED: 12/14/2023
EXPIRES: 6/11/2024
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 12/14/2023
PERMIT NUMBER
PLRS23-0204
ISSUED: 12/14/2023
EXPIRES: 6/11/2024
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
Plumbing Permit Application
City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED.
PERMIT
JOB ADDRESS:PROJECT VALUE $ 15,000
CD-NEW OR REP C M NTI S ALLATION and/or ORE-PIPE
TYPE OF FIXTURE
Bathtub
Clothes Washer
Dishwasher
Drinking Fountain
Floor Drain
Floor Sink
Hose Bibs
Kitchen Sink
Laundry Tray
Lavatory
Other Fixtures
OMISCELLANEOUS
Sewer Replacement
c)Back Flow Preventer
QTY TYPE OF FIXTURE
Septic Tank & Pit
Shower
Shower Pan
Slop Sink
QTY
Three Compartment Sink
Toilet
Urinal
Vacuum Breakers
Water Connected Appliances
Water Heater
Water Treating System
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. **
C] 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:
Plumbing Company:
Co. Address: I
License Holder:
Phone Number:
Office Phone:Fax
City:State.Zip:
s e Certification/Registration # CFC
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this —I-Cday the State Of Florida'
county of
• My
Jury oe.2027
Fb. HH 393388
Signature of Notary Publi
Personally Known OR [Produced Identification
Type of Identification:
Updated 10/11/23
PLRS23-0204