20 17th St PLRS19-0104 3 Fixtures PLUMBING RESIDENTIAL PERMIT PERMITNUMBER
3 CITY OF ATLANTIC BEACH PLRS19-0104
800 SEMINOLE ROAD ISSUED: 6/4/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 12/1/2019
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM • THE CURRENT 6TH EDITIONf OF THE FLORIDA BUILDING
• • • CITY OF ATLANTIC BEACH CODEOF ORDINANCE
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.
• • • . r • r • OF WORK:
2017TH ST PLUMBING RESIDENTIAL PLUMBING - 3 FIXTURES $1000.00
TYPE OF REALESTATE • SUBDIVISION:BUILDING USE
CONSTRUCTION: NUMBER: GROUP:
1695910010 OCEAN GROVE UNIT 01
• ADDRESS: CITY: STATE: ZIP:
1 WHITEHEAD PLUMBING 12811 BEAUBIEN RD JACKSONVILLE FL 32258
INC
• ADDRESS: CITY: STATE: ZIP:
SCHIFANELLA THOMAS I 2017TH ST ATLANTIC BEACH FL 32233-5810
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.
LISTOF CONDITIONS
Roll off container company must be on City approved list. Container cannot be placed on City right-of-way.
DESCRIPTION ACCOUNT QUANTITY PAIDAMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $5500
PLUMBING FIXTURES 455-0000-322-1000 0 $000
PLUMBING FIXTURES 455-0000-322-1000 3 $21.00
STATE DEEP SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$80.00
Issued Date:6/4/2019 1 of 2
ALL
" INFORMATIONPlumbin Permit Application HIGHLIGHTEDIN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
e—{I plFS_(9 -- o)
i oy-
PhonIe `9004) 2477-5826Email: Building-Dept@coab.us PERMIT Nfc5r 'V0J
JOB ADDRESS: , , gYldPROJECT VALUE$ /O 00
L1 NEW OR REPLACEMENT INSTALLATION and/or ORE-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 Z
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
LaundryTray Water Connected Appliances_
Lavatory �_ Water Heater
Other Fixtures O Water Treating System
❑MISCELLANEOUS
❑Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler heads)
❑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.
Owner Name: Sr�klwk Phone Number:
Plumbing Company: r- \ UVFl I � �N'� Office Phone:44�31P WP Fax
Co.Address: City: _ _State Ziip:r
License Holder: vWk State Certification/Registration N r/I V
Notarized Signature of License Holder
The forego ' strumen was acknowledged before me this+da On P •201 m the State of Florida,
County of
Signature of Notary Publi r9j d � Z'-_,
'c"GINGtESPEAGEB
uv couulssoneFF9zsss ersonally Known OR [ ] Produced Identification
ExPIREs.cxtober s.2019 Type of identification:
",t•R,Is, am,eeamv roar eoora u.a.;.trez
upeoreeio/vps
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