1132 BEACH AVE PLUMB PERMPLUMBING RESIDENTIAL PERMIT
Ji j1
CITY OF ATLANTIC BEACH
Vr
800 SEMINOLE ROAD
ATLANTIC BEACH. FL 32233
PERMIT NUMBER
PLRS19-0034
ISSUED: 2/12/2019
EXPIRES: 8/11/2019
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:
1132 BEACH AVE PLUMBING RESIDENTIAL PLUMBING - 15 FIXTURES $10000.00
170279 0000 ATLANTIC BEACH
ADDRESS:
ELITE PLUMBING LLC 944 STEEPLE CHASE LANE ORANGE PARK FL 32065
ADDRESS:
MOMS BEACH HOUSE LLC C/O SUSAN WEED MEMBER BRUSSELS BELGIUM
1200
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.
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
Issued Date: 2/12/2019 1 of 2
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
15
$105.00
STATE DBPR SURCHARGE
455-0000-208-0700
0
$2.40
STATE DCA SURCHARGE
455-0000-208-0600
0
$2.00
TOTAL: $164.40
Issued Date: 2/12/2019 1 of 2
Plumbing Permit Application
City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us
"ALL INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED.
PERMIT#: P U OQ3
JOB ADDRESS: nvE PROJECT VALUE 1 �'Jn CD
E] NEW OR REPLACEMENT INSTALLATION and/or 1:1 RE -PIPE
TYPE OF FIXTURE
QTY
TYPE OF FIXTURE QTY
Bathtub
Z
Septic Tank & Pit
Clothes Washer
Shower
Dishwasher
Shower Pan
Drinking Fountain
k'
Slop Sink
Floor Drain
X
Three Compartment Sink
Floor Sink
Toilet 3
Hose Bibs
2
Urinal
Kitchen Sink
t
Vacuum Breakers
Laundry Tray
x
Water Connected Appliances
Lavatory
Water Heater t
Other Fixtures
������ Water Treating System
❑ MISCELLANEOUS
1�
LJ 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 or local law regulation construction or the performance of construction.
Owner Name: How5 OCActi1 �axE Ue- Phone Number:
Plumbing Company: Rt+E Q64Ioiyc U -C Office Phone: 3iy - Io(,,z - Sg-73 Fax
Co. Address: 944 6+L_L_pleC'k4 l66 W City: t)EAu«P4k.k State: F Zip: 37Zat,C,
License Holder:
Notarized Signature of License Holder
State Certification/Registration # c.Fc_(yzq(433
The forego in strumentme s ay
as acknowledged before this of
County of 1/ /
Signat e of Notary
] Personally Known O
Type of Identif aint k__1,_ TONIGINDLI
jr
r--p__,U , 201 t, in the State of Florida,