262 S NAUTICAL BLVD PLUMB PERM PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0035
800 SEMINOLE ROAD
ISSUED: 2/13/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 8/12/2019
MUST CALL INSPECTION • • • 1 • + BY 4 PM FOR + INSPECTION.
ALL • 'K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • ' D+ 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: PERM IT TYPE: DESCRIPTION: VALUE OF WORK:
262 S NAUTICAL BLVD PLUMBING RESIDENTIAL re-pipe 15 fixtures $1500.00
TYPE OF
• • GROUP:
170703 0404 SEASPRAY
COMPANY: ADDRESS: CITY: STATE: ZIP:
EASTERDAY PLUMBING 6653 POWERS AVE APT 241 JACKSONVILLE FL 32217
INC
• ADDRESS:
JODY SOMMERS 1648 ATLANTIC BEACH DRIVE Atlantic Beach FI 32233
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 $1.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
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: $165.40
Issued Date: 2/13/2019 1 of 2
iS
Plumbing Permit Application "*ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 C G
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: PL 1 -S l—DC� S
JOB ADDRESS: &,29, fV �'{-�;�P�(��� i0',�i' , PROJECT VALUE
NEW OR REPLACEMENT INSTALLATION and/or ]RE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub _� Septic Tank& Pit
Clothes Washer �_ Shower t
Dishwasher Shower Pan I _
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
Ej Sewer Replacement
❑ Back Flow Preventer
v ❑ Lawn Sprinkler System (number of sprinkler heads)
❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Well **SIRWD 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: ' Phone Number:
Plumbing Company: � � ffice Phone: 9U V V/6 3 3
O � ax
Co. Address: S � � C `1AjS �i� ��i� . State: 7�/ Zip: SS'
License Holder: State Certification/Registration# (l`Cte / /
Notarized Signature of License Holder �1144;1
The foregoing instrument was acknowledged before me this l y off , 20 , in the State of Florida,
County of aA'-0J
"`,0r'P'�so JENNIFER CULPEPPER Signature of Notary Public�� N
Notary Public•State of Florida
Commission #GG 029188 [ ] Personally Known OR [`d Produced Identification
My Comm.Expires Sep 12,2020 Type of Identification: t V-0/
'' ,,,, • Bonded through National Notary Assn.
Updated 10/17/18
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