1921 Seminole Rd PLRS19-0097 4 Fixtures PERMITNUMBER
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH PLRS19-0097
800 SEMINOLE ROAD ISSUED: 5/21/2019
ATLANTIC BEACH.FL 32233 EXPIRES: 11/17/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORMTO THE CURRENT ISTH EDITION1 OF • • BUILDING
CODE, AND CITY OF • • 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:
1921 SEMINOLE RD PLUMBING RESIDENTIAL install 4 fixtures $4900.00
ZONING:TYPE OF REALESTATE SUBDIVISION:BUILDING USE
CONSTRUCTION: NUMBER: GROUP:
1695420530 BEACHSIDE
COMPANY: ADDRESS:
DUVAL CONSTRUCTION
INC 13221 Mendenhall PL JACKSONVILLE FL 32224
• ADDRESS: CITY: STATE: ZIP:
JONES RAYMOND E 1921 SEMINOLE RD ATLANTIC BEACH FL 32233-5903
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.
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455.000322-1000 0 $SS.00
PLUMBING FIXTURES 455-0000()-322-1000 4 $28.00
STATE OBPR SURCHARGE 455-0000-208-0700 0 $200
STATE OCA SURCHARGE 455-0000-208-0EW 0 $2.00
TOTAL:$87.00
Issued Date:5/21/2019 1 of 2
"ALL INFORMATION
Plumbing Permit Application HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 n p
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 'P L¢.S
5' I •�
JOB ADDRESS: Q7/ `1/P0� 032233 PROJECTVALUE$ 41VO-0c,
❑NEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower t
Dishwasher Shower Pan �—
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink _
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
LaundryTray Water Connected Appliances_
Lavatory Water Heater
Other Fixtures Water Treating System
❑MISCELLANEOUS
❑ Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System(number of sprinkler heads)
i7 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. Fiery �I
Owner Name: T r rLJ aE P '50yys Phone Number:
R`I 190 9
Plumbing Company: 0U 1/IR?2 COrV'rgr&2G!/0wi Office Phone: �B7—� Fax
Co.Address: /3M City: cYW Stater zip: :3222.9t
License Holder:_WW-pp State Certi 'cat n/Registration p C66143
Notarized Signature of License Holder G
The foregoing instrument was acknowledged before me this _day of lea , 20_1 in the State of Florida,
County of 09Li1.�
Signature of Notary Public
=JENNIKRIW� GN Ob1961personally Known OR[tj.Pfodu I tifitation
T.N2auw. � Type of Identification:�C���iL��f p-AS'�
Undm,1101v/Cie
NOTICE/� �O�F COMMENCEMENT
State of County of /1V//r7!/ Tax Folio No. 1469 532 -�53 o
To Whom It May Concern:
The undersigned hereby informs you that improvements will be made to certain real property,and in accordance with Section 713 of
the Florida Statutes,the following information is stat is NOTIC OF C MEN EMENT. /�
Legal Descriptlon ofpro rty being improved: — �I fl — S — 2Y
!3 ►�13/DE Jy7- R A2-K /
Address of properly being improved:_/�Qp yINy�is,�n..M i uaf&�CPa�a��Mn%*� t:ft �m.A�r�c eS�w .��33
General description of improvements: t 9T WA92jJ PfFH0 152
Owner: u Address: Mol Sf/VA'Vet 4`fNlt"-32O:
Owner's interest in site of the improvement:
Fee Simple Titleholder(if other than owner):
Name:
Contractor: 0111VAt X ,-5G�dV Ike,
Add AA2U/ Af
�40/�`,"��j�f *- P` 222
Telephone No.: Y�"�O/'G!/2� Fax No:
Surety(if any)
Address: Amount of Bond$
Telephone No: Fax No:
Name and address of anyperson making a to for the construction of the improvements
Name:
Address:
Phone No: Fax No:
Name of person within the State of FlorA�othffhimself, designated by owner upon whom notices or other documents maybe
served: Name:
Address:
Telephone No: Fax No:_ - - - — -
In addition to himself, owner designates d following person to rete Doc#2019117930,OR SK 18798 Page 2001,
ages:1
713.06(2)(b),Florida Statues. (Fill in at Or er's option) Recorded 0841/2019 10:48 AM,
Name: RONNIE FUSSELL CLERK CIRCUIT COURT DUVAL
COUNTY
Address: RECORDING $10.00
Telephone No: Fax No:
Expiration date of Notice of Commencement(the expiration date is one(1)year from the date of recording unless a different date is
specified):
THIS SPACE FOR RECORDER'S USE ONLY OWNER
Signed: Ilh W Dete:
Before me this day of n Ne County o Duval,State
,yn..yM EOM o VATA Pciowhese onfllly eDpeared fl N�
Cmry PUMIo,No,
Prouced denuwn; ; i
�Jb*� Cmm�naelan Na.G0711120 produced Identification;
.1' Commiselon expires 0/1112023 Notary Public: NO
My commission expires: