466 MAKO DR PLRS19-0014 plbg permit PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
PLRS19-0014
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED:
ATLANTIC BEACH. Fl.32233 EXPIRES:
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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: PERMITTYPE: DESCRIPTION: VALUE OF WORK:
466 MAKC) DR PLUMBING RESIDENTIAL install 9 fixtures $2400.00
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
1714780000 ROYAL PALMS UNIT
02A3.00
COMPANY: ADDRESS: CITY: STATE: ZIP:
PLUMBING BYJOSH INC 5659 FLORAL AVENUE JACKSONVILLE FL 32211
OWNER: ADDRESS: CITY: STATE: ZIP:
SALEM RAMSEY B 638 QUEENS HARBOR BLVD JACKSONVILLE FL 32225
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.
0
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 4S5-0000-322-1000 0 $55.00
PLUMBING FIXTURES 4S5-0000-322-1000 9 $63.00
STATE DBPR SURCHARGE 4S5-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 4S5-0000-208-0600 0 $2.00
TOTAL: $122.00�
Issued Date: 1 of 2
PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0014
ISSUED:
800 SEMINOLE ROAD
ATLANTIC BEACH. FL 32233 EXPIRES:
Issued Date: 2 of 2
Plumbing Permit Application OFFICE COPY "ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Build ing-Dept@coab.us PERMIT#:
JOB ADDRESS: qJ66 1-1,41'�Q 0e PROJECTVALUE$ "2- 2-0
[]NEW OR REPLACEMENT INSTALLATION and/or 0 RE-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
El MISCELLANEOUS
El Sewer Replacement
D Back Flow Preventer
El Lawn Sprinkler System (number of sprinkler heads)
El Grease Interceptor (Trap)_gallons (Requires 3 sets of plans)
E:i Well **SJRWD Well Completion Form.Completed form to be submitted to the Building Department for final inspection.
El 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: lel-I —Phone Number:
Plumbing Company: (4 _7�_ Office Phone:
Co. Address: S� 14_51a0441 "A'k City: State:
-Z"--t Zip:
License Holder: AtaieCertification/Registration # tfoj::�60430LSIV-
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this Atday oCTCVAVW , 20\9� in the State of Florida,
County of
Amanda Murdza Signature of Notary Public /tA,11
State of Florida
c
I Personally Known ORWrod V ed Identification
My Commission Expires 07/16/204ype of Identification:
Commission No. GG 184045
Updated 10/17118
Cash Register Receipt Receipt Number
City of Atlantic Beach R8624
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $55.00
PLRS19-0014 Address: 466 IMAKO DR APN: 171478 0000 $55.00
BUILDING SHOWER PAN 03/06/2019 RBE $55.00
BUILDING SHOWER PAN 03/06/2019 RBE 45500003221002 0 $55.00
TOTAL FEES PAID BY RECEIPT: R8624 $55.00
Date Paid: Monday, April 01, 2019
Paid By: PLUMBING BY JOSH INC
Cashier: CB
Pay Method: CREDIT CARD 15
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Printed: Monday,April 01, 2019 4:28 PM 1 of 1 4