332 4TH ST PLUMB PERM PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
ss�, CITY OF ATLANTIC BEACH PLRS19-0033
800 SEMINOLE ROAD
ISSUED: 2/12/2019
EXPIRES: 8/11/2019
ATLANTIC BEACH. FL 32233
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, 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:
332 4TH ST PLUMBING RESIDENTIAL PLUMBING - 26 FIXTURES $12000.00
TYPE OFILDING USE
ZONING: : � •
• • ' •
169816 0000 ATLANTIC BEACH
COMPANY: ADDRESS: '
COGBURN AND 5900 TOWNSEND BLVD APT S22 JACKSONVILLE FL 32211
WAKEFIELD PLBG
• ADDRESS: STATE:
JOOST STEPHEN 10743 WAVERLY BLUFF WAY JACKSONVILLE FL 32223
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 0 $0.00
PLUMBING FIXTURES 455-0000-322-1000 26 $182.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.56
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.37
TOTAL:$242.93
Issued Date: 2/12/2019 1 of 2
Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
( ` City of Atlantic Beach Building Department GRAY IS REQUIRED.
..._
800 Seminole Rd, Atlantic Beach, FL 32233 P U
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: STLT PROJECT VALUE $ l Z-,000.00
❑NEW OR REPLACEMENT INSTALLATION and/or ❑RE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub T 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 a•. Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater /
Other Fixtures L Water Treating System
❑MISCELLANEOUS
Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler heads)
C 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.
Owner Name: O p � ,-r'T AfMhone Number: !'G'J -ZY/" 0,310
Plumbing Company:r up..� f- WA(N�+e.l.� 4�t/, !Yffice Phone: �aV-j3Y- 3f.53 Fax
v
Co. Address: (j'w4u L Pja.s"4. i5k City: -�I_A-Z State:rL Zip: 3 zL Yy
License Holder: SLS (Al C4 nuR+–S S to Certification/Registration # G�� t`{2 VqO
Notarized Signature of License Holder
The forego In . strument as acknowledged efore met Is day 20in the State of Florida,
County of t ��
Signature of Notary Public
I n OR Produced Identification
Type -ficatiCMCGINDL
MY COMMISSION#FF 924951
EXPIRES:October 6.2019 updated 10/17/18
Bonded Thru Notary Public Underwriters