1900 SEMINOLE RD - PLUMBING PLRS19-0094 t`,'�''r�. PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
—`' +i` '�f PLRS19-0094
Jbr,.- CITY OF ATLANTIC BEACH ISSUED: 5/13/2019
V. 800 SEMINOLE ROAD EXPIRES: 11/9/2019
�'"yea`>�y ATLANTIC BEACH. FL 32233
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA 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: PERMIT TYPE: DESCRIPTION: VALUE OF WORK:
1900 SEMINOLE RD PLUMBING RESIDENTIAL PLUMBING -9 FIXTURES $5000.00
TYPE OF REAL ESTATE BUILDING USE
ZONING: SUBDIVISION:CONSTRUCTION: NUMBER: GROUP:
169527 0010 SECTION LAND
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
WOOTEN DANIEL 1900 SEMINOLE RD ATLANTIC BEACH FL 32233
MATTHEW
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 CONDITIONS
Roll off container company must be on City approved list. Container cannot be placed on City right-of-way.
I
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 9 $63.00
STATE DBPR SURCHARGE
455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE
455-0000-208-0600 0 $2.00
TOTAL:$122.00
Issued Date: 5/13/2019 1 of 2
E1 **ALL INFORMATION
r- Plumbing Permit Application HIGHLIGHTED IN
;-- '' ; City of Atlantic Beach Building Department0GRAY IS REQUIRED.
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'' / 800 Seminole Rd, Atlantic Beach, FL 32233 n // ,,hh
�r >; --- Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: PLRS(9 .0O 4
t.-
JOB ADDRESS: 1900 Seminole Rd.,Atlantic Beach, FL 32233 PROJECT VALUE $5,000.00
✓ NEW OR REPLACEMENT INSTALLATION and/or EIRE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer 1 Shower 1
Dishwasher 1 Shower Pan 1
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 1
Hose Bibs Urinal
Kitchen Sink 1 Vacuum Breakers
Laundry Tray Water Connected Appliances 1
Lavatory
1 Water Heater 1
Other Fixtures Water Treating System
❑MISCELLANEOUS
❑Sewer Replacement
❑Back Flow Preventer
❑Lawn Sprinkler System (number of sprinkles I, 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. **
ElOther
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: Daniel Wooten Phone Number: (352)219-5601
Plumbing Company: N/A Office Phone: Fax
Co. Address: 1\1(V\- e City: State: Zip:
License Holder: r— State Certification/Registration #
Notarized Signature of License Holder _ '>
The foregoi trument as acknowledged before me this I 13da o' IA _ ,
20t c in the State of Florida,
County of le A
.....7.,, ;Ni iGINDLESPERGER Signature of Notary Publi _ 'A c___ A
*?4',111 ;= h‘/:;OMMISSION#FF 924951 ^
a EXPIRES:October 6,2019
:fs,;:W'r Personally Known OR [ ] Produced Identification
•?aF��? u;:�::d Thru Notary PuCiic Undered�e..
Type of Identification:
Updated 10/17/18