1003 Jasmine St PLRS19-0099 3 Fixtures PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS39-0099
f, ISSUED: 5/22/2019
800 SEMINOLE ROAD
EXPIRES: 11/18/2019
ATLANTIC BEACH, FL 32233
INSPECTIONMUST CALL • • 1 BY
• .1
Y INSPECTION.
ALL WORK MUST • • ' . TO THE • • 1 OF • • ' BUILDING
CODE, NEC, IPMC, AND CITY OF ATLANTIC BEACH CODE OF ORDINANCES .
ALL CONDITIONS OF REA1
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.
3 fixtures for interior $750.00
1003 JASMINE ST PLUMBING RESIDENTIAL remodel
TYPE OF rSUBDIVISION:
ZONING: GROUP:
CONSTRUCTION: NUMBER:
170991 0010 ATLANTIC BEACH SEC H
GREEN BUILT
CONSTRUCTION & 3653 REGENT BOULEVARD, #306 JACKSONVILLE FL 32224
DEVELOPMENT
WERNER FRANK 1003 JASMINE ST ATLANTIC BEACH FL 32233-1816
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.
ffffr . .
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
455TOW-322-1000 0 $SS OU
PLUMBING BASE FEE $2100
PLUMBING FIXTURES 455-000-322-1000 3
0 $2,W
STATE OBPR SURCHARGE 45s-0000-208-0]00
0 52.W
STATE OCASURCHARGE 455-0OW-208-0600
Issued Date:5/12/2019
I oft
° PLUMBING RESIDENTIAL PERMIT PERMITNUMBER
CITY OF ATLANTIC BEACH PLRS19-0099
800 SEMINOLE ROAD ISSUED:S/22/2019
ATLANTIC BEACH, FL 32233 EXPIRES: 11/18/2019
TOTAL:$60.00
Issued Date:5/22/2019 2 oft
Plumbing Permit Application ""ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 QL4 S N —ID b"
Phone: (904) 247-5826 Email: Building-DeptCt@coab.us PERMIT#: 11('519 — o'39
JOB ADDRESS: (003 SASmt+sC ST A-SlA^Vtl t3es,.l.
PROJECT VALUE$_-75'0>o0
MEW OR REPLACEMENT INSTALLATION and/or EIRE-PIPE
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 I Vacuum Breakers
LaundryTray Water Connected Appliances_
Lavatory Water Heater /
Other Fixtures I Water Treating System
❑AISCELLANEOUS
[]Sewer Replacement
❑Back Flow Preventer
❑Lawn Sprinkler System (number of sprinkler heads)
Elrease Interceptor(Trap) gallons (Requires 3 sets of plans)
❑Well "SJRWO Well Completion Farm.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 specked 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: rILA/JIC WCan+eu "" Phone Number: 'LYe,-
Plumbing Company: G,"A 'L" *_ C"S'Tnvc`n-" Office Phone: 90'" '"6bl Fax
Co.Address:_ 3 (o S3 ReS e+,c (31vo City: 7Ila-`c -- Y
State: 1�Zip: 32-
'1-
License Holder: Q00 VNZ L)P')' r State Certification/Registration # C Fc 117 9 B b y
Notarized Signature of License Holder_Af/
The foregoing instrument was acknowledged before me this qday of�fq 20_L5 in the State of Florida,
Countyof WYCL`
F
=,�WIMI.OHN8'�",,St 14 Signature of Notary Public
GG pd2t.Wd27,N20 Personally Known OR U16roduced dentific tion
lwUntleA'"''°" Type of Identification:
Upoirdio/»/ie