1270 Ocean Blvd PLRS19-0101 5 Fixtures PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
p CITY OF ATLANTIC BEACH PLRS19-0101
^� 8005EMINOLE ROAD ISSUED: 5/28/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 11/24/2019
INSPECTIONMUST CALL •NE LINE (904
CODE, NEC, IPIMC, 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: VALUEOFWORK:
1270 OCEAN BLVD PLUMBING RESIDENTIAL PLUMBING -5 FIXTURES $1200.00
TYPE OF REALESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171823 0000 MANDALAY
COMPANY: ADDRESS:
1 WHITEHEAD PLUMBING 12811 BEAUBIEN RD JACKSONVILLE FL 32258
INC
• ADDRESS:
STONE MITCHELL A 1270 OCEAN BLVD ATLANTIC BEACH FL 32233-5742
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-
DESCR7IPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $5500
PLUMBING FIXTURES 455-0000322-1000 0 $000
PLUMBING FIXTURES 455 MM322-1000 5 $35.00
STATE 0BPR SURCHARGE 455 MW-2080200 0 $200
STATE DCA SUflCHARGE 7 455-0000-2080600 0 $200
TOTAL:$94.00
Issued Date:5/28/2019 1 of 2
Plumbing Permit Application "ALL INFORMATION
HIGHLIGHTED IN
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 PFFITM {�LFS�ci -Q(O I
JOB ADDRESS: a 1 1 PROJECT VALUE yy 1M
❑NEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE 4Ty 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 Vacuum Breakers
LaundryTray >� Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
❑MANEOUS
El Sewer
❑ Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler heads)
❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Well "SJRWO 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 rree,grulllapatti�ion construction or the performance of construction.
Owner Name: / �UNIr ,�t,� Phone Number:
Plumbing Company: tG T % O I �� _Office Phone: Fax
Co.Address: , City: State: Zip: __
License Holder: State Certification/Registration If
r
Notarized Signature of License Holder._ �9
The foregoingittcfrument w s acknowledged before me this�day f 2("T . 20 it the State of Florida,
County of
_ Siture of Notary Public
TOM GINOIESPERGER
MV-OMMIGGIONOFF924951
ExPIREs:Ocrobar s,zm9sonally Known OR [ ] Produced Identification
"a,;�.,;�a• a�m.aT�nMWPUElcum.mileajTypef Identification:
UOdaredl0117118