471 IREX RD PLUMB PERM PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0039
800 SEMINOLE ROAD
ISSUED: 2/15/2019
11—g! 19 EXPIRES: 8/14/2019
ATLANTIC BEACH. FL 32233
MUST CALL INSPECTION • •NE LINE (904) 2+ + BY + PM FOR + INSPECTION.
ALL • 'K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • '
CODEA. NEC, IPMC, OF BEACH CODEOF 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:
471 IREX RD PLUMBING RESIDENTIAL PLUMBING -SHOWER PAN $400.00
TYPE OF
• • GROUP:
171408 0000 ROYAL PALMS UNIT
02A3.00
I CITY: STATE: ZIP:
• ADDRESS:
TDG PLUMBING 4426 LOYS DR JACKSONVILLE FL 32246
•
ADDRESS: --CITY: STATE: ZIP:
FORDPHILLIPS PROPERTIES 1835 3RD ST N JACKSONVILLE FL 32250
L L C BEACH
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.
CONDITIONSLIST 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 45S-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 1 $7.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $66.00
Issued Date: 2/15/2019 1 of 2
rt�1Nii
Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 PL-F)S �C� —GOvC
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: cva-7
JOB ADDRESS: _ � ���� CL c PROJECT VALUE$
El NEW OR REPLACEMENT INSTALLATION and/or EJ RE-PIPE ' v
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
❑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.
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: '�-� p L`,,,. :�g Office Phone: 5-'q JA I Fax
Co. Address: L-1 \lf2 Loi p CL City:_ `���(a-� State: (:;"L zip: J 22y
License Holder CLFI J (Z r) State Certification/Registration #
Notarized Signature of License Holder
The foregoin trument w s acknowledged before me this day , 20E in the State of Florida,
County of
,�'>y•. TONIGINDLESPERGER Signature of Notary Publi
MY COMMISSION#FF 924951
s. EXPIRES:October 6,2019
Bonded 7h u Notary Public Underwriters
[ ] Personally Known OR [ ] Produced Identification
Type of Identification:
Updated 10/17/18