1011 Jasmine St PLRS19-0170 Shower Pan PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
PLRS19-0170
V� CITY OF ATLANTIC BEACH ISSUED: 9/16/2019
800 SEMINOLE ROAD
»r ATLANTIC BEACH. FL 32233 EXPIRES: 3/14/2020
MUST + LL INSPECTION • • • 1 + 247-5814 BY + PM FOR NEXT DAY INSPECTION.
ALL WORK MUST CONFORM TO THE CURRENT 6TH EDITION (2017) OF THE FLORIDA 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 OF WORK:
1011 JASMINE ST PLUMBING RESIDENTIAL SHOWER PAN $1425.00
TYPE OFBUILDING USE
ZONING: :D •
• • GROUP:
170990 0550 ATLANTIC BEACH SEC H
COMPANY: ADDRESS: '
ATLANTIC COAST 3653 REGENT BOULEVARD, #305 JACKSONVILLE FL 32224
PLUMBING CORP.
• ADDRESS:
BAJAGILOVIC SULEJMAN 1011 JASMINE ST ATLANTIC BEACH FL 32233-1816
ET AL
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.
s�
;f
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 1 $7.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000 208 0600 0 $2.00
Issued Date: 9/16/2019 1 of 2
PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
S
CITY OF ATLANTIC BEACH PLRS19-0170
V~ 800 SEMINOLE ROAD ISSUED: 9/16/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 3/14/2020
TOTAL: $66.00
Issued Date: 9/16/2019 2 of 2
Plumbing Permit Application * ALL INFORMATION
HIGHLIGHTED IN
r i City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 P i'RS�q _ N '7
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: Jo// CJ�}Sr��n-C- ST PROJECT VALUE $_�, Za • �p
❑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 Z
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
1-i Sewer Replacement
i i Back Flow Preventer
i_j Lawn Sprinkler System (number of sprinkler heads)
I I Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
Cl 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: �li,1' I m,i N Aq'�6-1'10111't Phone Number:
Plumbing Company: , , � T/ /h7 Office Phone: �y7 327& Fax
J Y 3.2A2
Co. Address: 6� ?i 1,1d City: c�j� State:�Zip:
License Holder: /c-�l o/q1 r' J State ification/Registration # (ireo �Sy✓
Notarized Signature of License Holderd'I'4 j�//
The foregoing instrume t was acknowledged before me this qday of s� , 20/�, in the State of Florida,
County of Dtl V/
DIANE 0.ROCHE ignature of Notary Public
MY COMMISSION#GG 117147
EXPIRES:June.21,2021 yy(ersonally Known OR [ ] Produced Identification
��F�;;;°`�' Bonded Thru Notmy Public Undervftera
ype of Identification:
Updated 10/17/18
r
yCash Register Receipt ReceiptNumber
yr
City of Atlantic Beach • ' •
DESCRIPTION
• QTY PAID
PermitTRAK $66.00
PLRS19-0170 Address: 1011 JASMINE ST APN: 170990 0550 $66.00
PLUMBING $62.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 1 $7.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
• R10282
$66.00
Date Paid: Monday, September 16, 2019
Paid By: ATLANTIC COAST PLUMBING CORP.
Cashier: CT
Pay Method: CREDIT CARD 04472Z
I
Printed: Monday,September 16, 2019 1:08 PM 1 of 1 1