1120 Ocean Blvd PLRS19-0115 20 Fixtures,srLjf�„ PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH
PLRS19-0115
v�
800 SEMINOLE ROAD ISSUED: 6/13/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 12/10/2019
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:
/ OCEAN BLVD PLUMBING PLUMBING - 20 $1900.00
170285 0000 ATLANTIC BEACH
COMPANY:ADDRESS:
CUSTOM PLUMBING AND 2742 SETTLEMENT DR JACKSONVILLE FL 32226
TILE
• ADDRESS:
JEFF CHARTRAND 1120 OCEAN BV ATLANTIC BEACH FL 32233-5740
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.
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
455-0000-322-1000
0
$55.00
PLUMBING FIXTURES
455-0000-322-1000
0
$0.00
PLUMBING FIXTURES
455-0000-322-1000
20
$140.00
STATE DBPR SURCHARGE
455-0000-208-0700
0
$2.93
STATE DCA SURCHARGE
455-0000-208-0600
0
$2.00
TOTAL: $199.93
Issued Date: 6/13/2019 1 of 2
ty' Plumbing Permit Application
ft' City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
Ph/one: (904) 247-5826 Email: Buildin -De 1
JOB ADDRESS: ! l A 0- OCCQ-, 61
❑NEW OR REPLACEMENT INSTALLATION and/or ORE -PIPE
**ALL INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED.
coab.us PERMIT#:�es
PROJECT VALUE $
PLRst9 -01 ks
OF FIXTURE QTY
TYPE OF FIXTURE
QTY
Bathtub 1
Septic Tank & Pit
Clothes Washer
Shower
3
Dishwasher 1
Shower Pan
Drinking Fountain
Slop Sink
Floor Drain
Three Compartment Sink
Floor Sink
Toilet
5
Hose Bibs
Urinal
Kitchen Sink
Vacuum Breakers
Laundry Tray
Water Connected Appliances
Lavatory _� Water Heater L
Other Fixtures Water Treating System
E] MISCELLANEOUS
Lj CU
Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler heads)
❑ 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. **
❑ 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: e � (',yNcAf-q-r%-& Phone Number:
Plumbing Company: CuST�lu�''t/�i%u1 �T��� Office Phone: f0'(/- 4f&0-W1S7Fax
Co. Address: �� �2 5-c-444-f—e-AL 617— City: State: Zip:
License Holder:
�{c,t�a.g (�IAc,tc3uren�
Notarized Signature of License Holder
C1
4'1L--
State Certification/Registration # CK /`/.273 p'1
LJ
The foregoin i trumentas acknowledged before me this I �da
County of al
TON1 GINDLESPERGER
MY COMK"ISSION # FF 924951
-`: EXPIRES: October 61 2019
Bonded Thru Notary Public Undernriters
Signature of Notary Public
20 k ► in the State of Florida,
[ ] Personally Known OR]/P;roduced Identification
Type of Identification: &47 (— 3 - 7(P %o
Updated 10/17/18