405 SKATE RD PLUMB PERM PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
PLRS19-0026
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 1/28/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 7/27/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL • •K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • ' + BUILDING
CODE, AND OF ATLANTIC BEACH • 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:
405 SKATE RD PLUMBING RESIDENTIAL install 10 fixtures $2500.00
TYPE OF
ZONING: :D •
• • GROUP:
171530 0000 ROYAL PALMS UNIT
02A3.00
• ADDRESS:
FIRST COAST PLUMBING
117 Macon RD PALATKA FL 32177
INC
•
ADDRESS: CITY: STATE: ZIP:
MIKE & AMY FRANQUI 405 SKATE RD ATLANTIC BEACH FL 32233-3821
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 10 $70.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$129.00
Issued Date: 1/28/2019 1 of 2
PERMIT NUMBER
PLUMBING RESIDENTIAL PERMIT
rPLRS19-0026
CITY OF ATLANTIC BEACH
v 800 SEMINOLE ROAD ISSUED: 1/28/2019
�F3 ATLANTIC BEACH, FL 32233 EXPIRES: 7/27/2019
Issued Date: 1/28/2019 2 of 2
L�
* ALL INFORMATIONPlumbin Permit Application HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 �� L �_� }�I bU%a �o
Phone: (904) 247-5826 Email: Bui din -Det coab.us PERMIT#: 7;51� Uol
JOB ADDRESS: `ir D.� S �-Gt 7 1f 1 ��`'1 G Orae t 3�3PROJECT VALUE $ aS-00
El NEW OR REPLACEMENT INSTALLATION and/or ❑RE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer t Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 3,
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater I
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.
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::14���� FrCl kUb4 I Phone Number: 6�/ " 7,
Plumbing Company
Office Phone: Fax
Co. Address: /�ctwr? City: poi/o C State: 1--Z-Zip: 3,)-112
LicenseHolder: A10 aeCertification/Registration # Ge [ /25-9o�
Notarized Signature of License Hold
The foregoing instrument was acknowledged before me this day of aAL.-c-'1-j20 ( `d in the State of Florida,
County of Oi,J`Z l
Signature of Notary Public
l p-JENNIFER JOHNSTON
;� [ ] Personally Known OR [0-Produced Identification
''• - MY COMMISSION#GG 042984
= = EXPIRES:October 27,2020 Type of Identification: I--
=.:
>,r Bonded Tlw Notary Public Underwriters
•.°;;k• Updated 10/17/18