1380 East Coast Dr PLRS19-0119 15 Fixtures PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
Y \
CITY OF ATLANTIC BEACH PLRS19-0119
v~ 800 SEMINOLE ROAD ISSUED: 6/14/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 12/11/2019
MUST CALL INSPECTION • • • 1 BY 4 PM FOR ' •
ALL WORK MUST CONFORMTO THE CURRENT 6TH EDITION1 OF • '
CODE, NEC, IPMC, 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: VALUE OF WORK:
1380 EAST COAST DR PLUMBING RESIDENTIAL PLUMBING - 15 FIXTURES $5700.00
TYPE OF
• • GROUP:
171904 0000 SELVA MARINA UNIT 01
COMPANY: ADDRESS:
COG BURN AND
WAKEFIELD PLBG 17C Ponte Vedra Ct Ponte Vedra Beach FL 32082
• ADDRESS:
OLSEN DOROTHY J TRUST 1380 EAST COAST DR ATLANTIC BEACH FL 32233-5522
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 • •
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 15 $105.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.40
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $164.40
Issued Date: 6/14/2019 1 of 2
�( Plumbing Permit Application **ALL INFORMATION
t fir'\ HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
` 800 Seminole Rd, Atlantic Beach, FL 32233 P LRc
Phone: (904) 247-58826 Email: Building-Dept@coab.us PERMIT#: ?ESA- II - voll
JOB ADDRESS: )3 B eAs - lSeA-s-� D f--_ PROJECT VALUE$
❑NEW OR REPLACEMENT INSTALLATION and/or EIRE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer I Shower
Dishwasher l Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet .3
Hose Bibs 4 Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 3 Water Heater
Other Fixtures 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 **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. o�
Owner Name: � OSS �J `AJ U Phone Number: Ia�' Z�E�� 03 O
Plumbing Company: Cab U 12r- 4- Office one: 4107 33 y 379 Fax
Co. Address: ��3U L?�Q "A fkr✓� �� City: � State:F—(— zip:
License Holder: v State ertification/Registration # (:�'R t1-{2_ 1`10
Notarized Signature of License Holder
The foregoing ns ument wa acknowledged b ore me this day of , 20�, n the State of Florida,
County of
Signature of Notary Public
:;a;,•, TONIGINDLESPERGER Personally Known OR [ ] Produced Identification
MYCOMMISSION#FF924951 ype of Identification:
EXPIRES:October 6,2019
'e p`, �",•'� Bonded Thru NotaryPubl'ic Underwriters Updated 10/17/18