1912 N SHERRY DR PLRS19-0049 PLUMB PERM PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
r s; PLRS19-0049
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ISSUED: 3/6/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 9/2/2019
MUST CALL INSPECTION PHONE • 1 + ; • BY 4 PM FOR + INSPECTION.
ALL • ' K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • ' + BUILDING
CODE, AND OF ATLANTIC + CH 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: PERMITTYPE: DESCRIPTION: VALUE OF WORK:
1912 N SHERRY DR PLUMBING RESIDENTIAL PLUMBING - 26 FIXTURES $12000.00
TYPE OF
• • GROUP:
SELVA MARINA UNIT
172020 0826
lOC
• ADDRESS: STATE:
Superior Plumbing 8235 Dickie Drive Jacksonville FL 32216
• ADDRESS:
BAILIE FRANCES A 1912 SHERRY DR N ATLANTIC BEACH FL 32233-4520
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.
= d
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 4S5-0000-322-1000 0 $55.00
PLUMBING FIXTURES 45S-0000-322-1000 0 $0.00
PLUMBING FIXTURES 455-0000-322-1000 26 $182.00
STATE DBPR SURCHARGE 4S5-0000-208-0700 0 $3.56
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.37
TOTAL: $242.93
Issued Date: 3/6/2019 1 of 2
Plumbing Permit Application **ALL INFORMATION
-� HIGHLIGHTED IN
r City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JO ADDRESS: (�- IV SL.r_�-c��i D PROJECT VALUE$ I (300
NEW OR REPLACEMENT INSTALLATION and/or �RE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower 3
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
rXIL0
Ll Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler ads))
❑ 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: l`Z ._L " Phone Number:
Plumbing Company: Sve c,5' of .ill U r,\b,,•?C Office Phone: 1e1 OLIO'SS-18�z Fax
Co. Address: ��60 'v� 1 \`, e d City: -> State: Zip:
License Holder: S P�1\ �� -S� `� State Certification/Registration # KI 11 0 0 6�$
Notarized Signature of License Holder
L
The foregoi *nstrument as acknowledged before me this�d of C20the State of Florida,
County of o
Signature of Notary Public
[ ] Personally Known OR [ ] Produced Identification
v� TONI GINDLESPERGER7�
My COMMISSION*Fr-924951 Type of Identification: SS4 C? --7 S --9 3 1 0z-7. ! 0
P' EXPIRES:October 6,2019
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Updated 10/17/18
Bonded Thru Notary Public Undo nters