90 S Forrestal Cir PLRS19-0121 2 Fixtures 4' PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
i' PLRS19-0121
.. , CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 6/19/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 12/16/2019
MUST CALL INSPECTION • • • 14) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
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,
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: PERMITTYPE: DESCRIPTION: VALUE OF WORK:
90 S FORRESTAL CIR PLUMBING RESIDENTIAL PLUMBING - 2 FIXTURES $850.00
TYPE OF
• • GROUP:
171751 0000 4TLANTIC BEACH VILLA #
01
COMPANY: ADDRESS: CITY: STATE: ZIP:
ADVANTAGE PLUMBING 880 MAYPORT RD JACKSONVILLE FL 32240
BEACH
• ADDRESS:
TYSINGER MARK 90 FORRESTAL CIR S ATLANTIC BEACH FL 32233
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 2 $14.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
Issued Date: 6/19/2019 1 of 2
f'
PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0121
800 SEMINOLE ROAD ISSUED: 6/19/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 12/16/2019
TOTAL: $73.00
Issued Date:6/19/2019 2 of 2
ALL
Plumbing Permit Application **HIGHLIGHTEDIION
• �" HIGHLIGHTED IN
_ City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 -
P LRSFO( Z l
1
Phone: (904)
(904) 24fio
7-n5826 Email: Building-Dept@coab.u` PERMIT#:
JOB ADDRESS: "1(; I�QC��/,d� �1���) _ PROJECT VALUE $ S� Q
✓NEW OR REPLACEMENT INSTALLATION and/or DRE-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 Vacuum Breakers .
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
❑MISCELLANEOUS
❑Sewer Replacement
❑Back Flow Preventer
❑Lawn Sprinkler System (number of sprinkler heads)
03rease 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: kc�.r�, L4 S jns;-4 -'_ r Phone Number:
Plumbing Company: y
p y: ��U�� 06,47 �J��WGOffice Phone: �- ���� Fax
Co. Address: 'CT( City: state: -
&-zip:
License Holder: 7 U s S a Certification/Registration #
Notarized Signature of License Holder
The foregoing instrument was acknowledged before e this J day of L -�( 120 , in the State of Florida,
County of 'h1,f I","
Signature of Notary Public
TRACY WATERUM
MY COMMMION#00 Personally Known OR [ J Produced Identification
MMM Wo"wim20.2022
t
80WWnftN"yPdfaType of Identification:
Updated 10/17/18