2233 Seminole Rd #9 PLRS19-0187 9 Fixtures ro.A.„,,,, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER it''
�` CITY OF ATLANTIC BEACH PLRS19-0187
or z ISSUED: 9/30/2019
800 SEMINOLE ROAD
010%4 ATLANTIC BEACH. FL 32233 EXPIRES: 3/28/2020
MUST CALL INSPECTION PHONE LINE (904) 247-5814 BY 4 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:
2233 SEMINOLE RD UNIT 9 PLUMBING RESIDENTIAL PLUMBING - 9 FIXTURES $3200.00
TYPE OF I REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169519 0118 OCEAN VILLAGE ONE
CONDO
COMPANY: ADDRESS: CITY: STATE: ZIP:
COGBURN AND
WAKEFIELD PLBG 17C Ponte Vedra Ct Ponte Vedra Beach FL 32082
OWNER: ADDRESS: CITY: STATE: ZIP:
PETWAY BRETTE 1535 UPLAND AVE BOULDER CO 80304
ELIZABETH TRUST
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 CONDITIONS
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 9 $63.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
Issued Date: 9/30/2019 1 of 2
t Api,,, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
J a L ° f CITY OF ATLANTIC BEACH PLRS19-0187
J� r 800 SEMINOLE ROAD ISSUED: 9/30/2019
`'rt V ATLANTIC BEACH. FL 32233 EXPIRES: 3/28/2020
I
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $122.00
Issued Date:9/30/2019 2 of 2
Plumbing Permit Application **ALL INFORMATION
�� HIGHLIGHTED IN
f-----
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 P1—RSi 9 _c:: I S7
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: -I- t":53-I- t":53 S-e,,,. ; - c(- ' ON( 1 gPROJECT VALUE $ 3 Zo 0
❑NEW OR REPLACEMENT INSTALLATION and/or ❑RE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer Shower
Dishwasher Shower Pan l
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet �--
Hose Bibs Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory CP— ater Heater ___(
Other Fixtures ater Treating System
❑MISCELLANEOUS
Sewer Replacement
Back Flow Preventer
[ i Lawn Sprinkler System (number of sprinkler heads)
F7 Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
I-J 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 I I law regulation construction or the performance of construction.
Owner Name: �S Cep (CS�l. l d4 may 6,,r-� _
Phone Number: 7,`< <. 032-0
�/�be q
Plumbing Company:t (a --F C A _Rc.ta e�'`iOff Phone: 1 61 -33-1-310 Fax
Co. Address: r7?q Cc(U -'4- /4,a.-(k-- City: 'TIP-I- State:FC Zip: ) (IL(
License Holder: j 1^" Cs Jia."---) State Certification/Registration # CF(....l--(Z 81 No
Notarized Signature of License Holder -
The forego . instrument as acknowled d before e this ay of- . _ 20 Qin the State of Florida,
County of 0 V
Signatur of Notary Public q--- i) 1/4z.,d-----' —
a". TONI GINDLESPERGER
f.. L, 1. MY COMMISSION#FF 924951 Personally Known OR [ ] Produced Identification
• ... .. , EXPIRES:October 6,2019 Type of Identification:
4T., ...' Bonded Thru Notary Public Underwriters
Updated 10/17/18