130 5th St PLRS19-0161 Install Fixtures for Garage � PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
r S; PLRS19-0161
-�, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 8/29/2019
ATLANTIC BEACH, FL 32233 EXPIRES: 2/25/2020
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 PM FOR NEXT DAY INSPECTION.
ALL •RK MUST CONFORM TO THE CURRENT ISTH EDITION1 OF • D+ 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: PERMITTYPE: DESCRIPTION: VALUE OF WORK:
130 STH ST PLUMBING RESIDENTIAL install 23 fixtures for new $12000.00
garage, mod. foundation
TYPE OF
• • GROUP:
170168 0000 ATLANTIC BEACH
• ADDRESS: CITY: STATE: ZIP:
SWEENEY REMODELING 14047 MOUNT PLEASANT ROAD JACKSONVILLE FL 32225
AND PLUMBING
• ADDRESS:
DIAZ MICHAEL K 130 5th 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 • 9
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 23 $161.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.24
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.16
TOTAL:$221.40
Issued Date:8/29/2019 1 of 2
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax(904)247-5845 p
JOB ADDRESS: ! 3Q �� ��-• PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$ 11 ,V00
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 2 Septic Tank&Pit —
Clothes Washer �_ Shower 3
Dishwasher Shower Pan
Drinking Fountain Slop Sink -
Floor Drain Three Compartment Sink —
Floor Sink — Toilet
Hose Bibs 3 Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray a Water Connected Appliances
Lavatory (o Water Heater
Other Fixtures Water Treatin System
RE-PIPE: 2 3
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:
ewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well **
**SJR WD 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.
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PhoneNber �oProperty Owners Name 03 6U 3
Plumbing Company nnh, fce
Phone 10 10 3 t fax
Co. Address: A t.wf Lk �kity State Zip jZ L z--j
License Holder(Print): State Certification/Registration# 0 6� /e/ M S
Notarized Si natr older
=o Hr P, .•
JENNIFER JOHNSTON
MY COMMISSION#GG 042984 Before a this _day of 20�
EXPIRES:October 27,2020
Bonded hru Notary Public Underwriters Signature of Notary Public
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