817 BONITA RD PLRS19-0013 PLUMBING PERMIT PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0013
V~ 800 SEMINOLE ROAD ISSUED: 1/14/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 7/13/2019
MUST CALL INSPECTION PHONE • 1 . . BY , PM FOR . 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: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
817 BONITA RD PLUMBING RESIDENTIAL INSTALL 12 FIXTURES FOR $9000.00
INTERIOR REMODEL
TYPE OF +
ZONING: :D •
• • GROUP:
171153 0000 ROYAL PALMS UNIT 01
COMPANY: ADDRESS:
KELLEY'S PLUMBING
CONTRACTING 3866 VALENCIA RD JACKSONVILLE FL 32205
OWNER: . • • • CITY: STATE: ZIP:
CHRISTOPHER J ROOD 509 9TH ST JACKSONVILLE FL 32250
BEACH
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 . •
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 12 $84.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.09
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
Issued Date: 1/14/2019 1 of 2
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* IINFORMATIONPlumbin Permit Application HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
D
�i OI�
800 Seminole Rd, Atlantic Beach, FL 32233 �L-QSIS
Olt Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 1S /7 lam- �� PROJECT VALUE$ �(C 0C)C
NEW OR RCPLACEME INSTALLATION and/or ORE-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 Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
❑MISCELLANEOUS
❑ Sewer Replacement
❑ Back 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
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
,,orlllocal law regulation construction or the performance of construction.
Owner Name: !"'/C-A*Z 141a/V L Phone Number: gdl1y S-7Z-7,75
Plumbing Company: /G�� S f ✓lr 6-'-1-1Wtff�ice Phone: 9�`�'3 - -/Fax
Co. Address: 3S LD v/--��4- �'s`� City: C� State: ft Zip:
License Holder: L -✓ !LC`LV� State Certification/Registration # C'//Ote7S�7
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this Nday of 1 a201` , in the State of Florida,
County of B�,LVct
Signature of Notary Public _
1
JE
,:�R`.....�: NNIFER JOHNSTON
MY COMMISSION#GG 042984 [ ) Personally Known OR [�roduce Identification `
P` EXPIRES:October 27 Type of Identification: ('L (I J9y S CC �y
%F;°• Bonded 2020
'• Thru Notary public Underwriters Updated 10/17/18
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Receipt Number
Cash Register Receipt
City of Atlantic Beach • i i
DESCRIPTION ACCOUNTCITY PAID
PermitTRAK $55.00
PLRS19-0013 Address: 817 BONITA RD APN: 171153 0000 $55.00
PLUMBING TOP OUT 02/21/2019 RBE $55.00
PLUMBING TOP OUT 02/21/2019 RBE 45500003221002 0 $55.00
• 11
Date Paid: Thursday, February 28, 2019
Paid By: KELLEY'S PLUMBING CONTRACTING
Cashier: CB
Pay Method: CREDIT CARD 92748
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Printed:Thursday, February 28, 2019 10:40 AM 1 of 1 4