1067 BEACH AVE PLRS19-0050 PLUMB PERM PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
r CITY OF ATLANTIC BEACH PLRS19-0050
800 SEMINOLE ROAD ISSUED: 3/7/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 9/3/2019
MUST CALL INSPECTION • • • • / BY 4 PM FOR • •
ALL • ' K MUST CONFORM TO THE CURRENT 6TH EDITIONi OF • '
CODE, AND OF ATLANTIC BEACH • OF ORDINANCES .
ALL • i OF PERMIT APPLY, ,SE 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.
PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
JOB ADDRESS: —1
1067 BEACH AVE PLUMBING RESIDENTIAL GARAGE - 7 FIXTURES $3800.00
TYPE OF
• • • '
170267 0000 ATLANTIC BEACH
• ADDRESS: �•
STYLES SMITH PLUMBING 1537 PENMAN RD SUITE A JACKSONVILLE FL 32250
BEACH
• ADDRESS:
MANDARIN EMPORIUM 2240 MAYPORT RD #7 ATLANTIC BEACH FL 32233
INC
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.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 4SS-0000-322-1000 0 $55.00
PLUMBING FIXTURES 45S-0000-322-1000 0 $0.00
PLUMBING FIXTURES 4SS-0000-322-1000 7 $49.00
STATE DBPR SURCHARGE 45S-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 4SS-0000-208-0600 0 $2.00
Issued Date: 3/7/2019 1 of 2
ALL
Plumbing Permit Application **HIGHLI HIGHLIGHTED
IN HIGHLIGHTED IN
l s City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 PL P S l9 -005Z
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:14(-(,/�5 -60y9
JOB ADDRESS: IOo7 13e,-,6L► .14 y , PROJECT VALUE $ �00, 00
L1 NEW OR REPLACEMENT INSTALLATION and/or El RE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower 1
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 I
Other Fixtures Water Treating System
L1 MISCELLANEOUS
Ll 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. **
El Other ��afan e- o dd1 f;o,1 w .tky(25fc,;r5 )3Attif07r7.
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: LL Phone Number:
Plumbing Company: �J7V1e5 p/"''Ib. dffice Phone: a��� ' 3 Fax
Co. Address: )53 7 Re'ly--w ,/ d• City: c-X L3 eekC�7 State: FL Zip: 3 SO
License Holder: � 1�� 15/1 r ff State Certification/Registration#GrG
Notarized Signature of License Holder % —
The forego nKinstru meny was acknowledged before me this-�7--d y o , 26, in the State of Florida,
County of ,
Signature of Notary Public
70NIGINDLESPERGER Personally Known OR [ ] Produced Identification
�+ MY COMMISSION#FF 924951
*= Type of Identification:
EXPIRES:October 6,2019
�;=� Bonded Thro Notary Public Underxr rs
�. ___------
Updated 10/17/18
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