778 VECUNA RD - PLUMBING j,i PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
�: CITY OF ATLANTIC BEACH PLRS19-0003
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ISSUED: 1/3/2019
� 800 SEMINOLE ROAD EXPIRES: 7/2/2019
ATLANTIC BEACH. FL 32233
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: I PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
778 VECUNA RD PLUMBING RESIDENTIAL install 28 fixtures $4720.88
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171353 0000 ROYAL PALMS UNIT 02A
COMPANY: ADDRESS: CITY: STATE: ZIP:
SUNSHINE STATE
PLUMBING 710 Haines Street Jacksonville FL 32202
OWNER: ADDRESS: CITY: STATE: ZIP:
Porter Mason 1340 Trailwood Drive Neptune Beach FL 32266
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.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 45S-0000-322-1000 28 $196.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.77
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.51
4 TOTAL:$257.28
Issued Date: 1/3/2019 1 of 2
a
rt1:1,�� ,,, Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
--?•.," --} " City of Atlantic Beach Building Department GRAY IS REQUIRED.
t :,
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: PL-e-S1 _`_ 0003
JOB ADDRESS: 77, ' V C.unA r,, PROJECT VALUE $ 4/7 20. 22
[NEW OR REPLACEMENT INSTALLATION and/or EIRE-PIPE
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TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY Ofr
Bathtub Z Septic Tank & Pit
Clothes Washer / Shower Z
Dishwasher / Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 3
Hose Bibs c/ Urinal
Kitchen Sink / Vacuum Breakers
Laundry Tray / Water Connected Appliances Z
Lavatory L/ Water Heater /
Other Fixtures _ Water Treating System
❑VIISCELLANEOUS
❑Sewer Replacement
DBack Flow Preventer
❑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 Sq/rtnrlfr /,llrA q, r. 'i-/ , av evrs1-rnctl10r
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: /7Rj6,7 Por It r- > Phone Number: 909-.rsa-2.09iPlumbing Company:S&gsf,;n.� .hie �1z �r6. ,79 Office Phone: 9P -ZGZ-4 Fax
Co. Address: 7/0 !-/z/7, .1/. City: `ac,esa, v//l/ State: ct Zip: ??ZD Z
License Holder: P'l,e 4a e j %, ic:?_,i- -n - State Certification/Registration # CFc• /c/lp -9
Notarized Signature of License Holder /]f4*
The foregoing, instrument was acknowledged before me this -- day of )c:,l,.A,4-uj , 20 r r , in the State of Florida,
County of `)Vft(
Si nature of NotaryPublic \ ;
g
Q0!Yvpee DAYINAR DICKERSON
• [ Personally Known OR [ ] Produced Identification
Commission#GG 148032
.• J= Expires October 22,2021 Type of Identification:
,:.,,,,,l'' fi`y' , Budget Notary y Updated 10/17/18