349 3rd St PLRS19-0142 7 Fixtures rt�'Jlr% PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
r, CITY OF ATLANTIC BEACH PLRS19-0142
800 SEMINOLE ROAD
ISSUED: 7/16/2019
r`01319" ATLANTIC BEACH. FL 32233 EXPIRES: 1/12/2020
MUST CALL INSPECTION • • • 1 i 247—S814 BY 4 PM FOR NEXT DAY • •
ALL • 'K MUST CONFORM TO THE CURRENT 6TH EDITION1 OF • ' + BUILDING
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 IF
349 3RD ST PLUMBING RESIDENTIAL PLUMBING - 7 FIXTURES $1200.00
TYPE OF
ZONING: :D •
• • • '
169823 0000 ATLANTIC BEACH
COMPANY: ADDRESS:
+ '
EARY PLUMBING 1870 Swiss Oaks St ST JACKSONVILLE FL 32259
OWNER: ADDRESS:
HOFFMAN DAVID A 349 3RD ST 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 7 $49.00
STATE DBPR SURCHARGE 45S-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $108.00
Issued Date: 7/16/2019 1 of 2
t��yr Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 P LAS CU ( 4- z
C,*�, Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: ;f-r Ll fi- L",X L,.ti '3z2-33 PROJECT VALUE$ t2,-�>j
❑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 'L-
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory , Water Heater
Other Fixtures Water Treating System
❑MISCELLANEOUS
❑ Sewer Replacement l
❑ 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: +,4-ok'n Phone Number: 1/o`1 V2 Z V?S—
Plumbing Company: 1 lw(V ac-"o': SCI' Office Phone: yny loo���� Fax
Co. Address: 1920 7o f"55 '4S City: ft-TOL"'s State: Fl- zip: �:2 2J-'
License Holder: State Certification/Registration# GF0 1' 2 �tiZ
Notarized Signature of License Holder J
The foregoing ' strument as acknowledged before me this l jddaof , 20D in the State of Florida,
County of
Signature of Notary Publl
g Y
TONI GINDLESPERGER
TMs. . [ ] Personally Known OR [ ] Produced Identification
MY COMMISSION#FF 925951
who EXPIRES:October 6,2019 Type of Identification: �oC'X�- d75 'g�- 7 -
%dc' d Bonded Thru Notary Public Underwriters
t- Updated 10/17/18