66 S Forrestal PLRS18-0292 °>. PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS18-0292
151ISSUED: 12/10/2018
o 800 SEMINOLE ROAD EXPIRES:6/8/2019
a` ATLANTIC BEACH. FL 32233
MUST CALL
Y 4 PIM FOR NEXT DAY INSPECTION.
• , K MUST INSPECTION• • . • • , • t OF • • •A BUILDING
ALL
CODE, NEC, IPIMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF PERMIT APPLY, PLEASE READ CAREFULLY.
FNOTIC.E:In addition to the requirements of this permit,there may be additional restrictions applicable to this property
ay be found in the public records of this county,and there may be additional permits required from other
mental entities such as water management districts,state agencies,or federal agencies.
•
665 FORRESTALCIR PLUMBING RESIDENTIAL $4500.00
TYPE OF ZONING: • : .
CONSTRUCTION:
• ATLANTIC BEACH VILLA p
171757 0000 01
Superior Plumbing
8235 Dickie Drive Jacksonville FL 32216
• • . •
Autumn Brook Design 5569 Autumnbrook Ct Jacksonville FL 32258
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.
"DESCRIP.TIOIN ACCOUNT QUANTITY PAID AMOUNT
455-0000-321-1000 0 555.00
FEE $98.00
PLUMBING FIXTURES 455-0000 322-1000 14
455-0000-108-0700 0 $2.30
STATE DePR SURCHARGE $2.00
STATE DCA SURCHARGE 455-0000-208OS00 0
TOTAL:$157.30
Issued Date:12/10/2016 1 of 2
INFORMATIONPlumbin Permit Application HIGHLIGHTEDIN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
PL
_S i1 C, Z 12-
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: >-b6��
JOB ADDRESS: E, �.Ir r ] LS 5ds1T"PROJECT VALUE $ LI i J Cid
❑NEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtubs Septic Tank& Pit
Clothes Washer �_ Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink U�
Floor Sink Toilet 3
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances_
Lavatory MI Water Heater _I
Other Fixtures Water Treating System
❑MISCELLANEOUS
El Sewer Replacement
❑ Back 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
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.
4�
Owner Name: Dan S &i<1n 6ohb-e( t Phone NumQbe�rq oLl
Plumbing Company: -SU Q-C fO
, j RlU M71R)Office Phone: oNl�-SJ-.` ' ax
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Co.Address: D-$60 \A(d hf� c)S City: . L . -S State: E�Zip:
License Holder: -�Ok < n a � —5Mf State Certification/Registration# `fl 0696-;bg
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this_Lday of Cre in the State of Florida,
County of 1i&Ln
Signature of Notary Public
dMIE D.SMITH
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[ ] Personally Known O oduced Identification
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FOMeAThu NowYl'�d0�u,a..,c«, Type of Identification:
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