399 5th St PLRS19-0196 2 Fixtures f-51-i- ir%„. PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
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CITY OF ATLANTIC BEACH PLRS19-0196
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� �,/ 800 SEMINOLE ROAD ISSUED: 10/18/2019
,i"rATLANTIC BEACH. FL 32233 EXPIRES: 4/15/2020
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:
399 5TH ST PLUMBING RESIDENTIAL PLUMBING - 2 FIXTURES $2000.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169881 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
ATLANTIC COAST 3653 REGENT BOULEVARD,#305 JACKSONVILLE FL 32224
PLUMBING CORP.
OWNER: ADDRESS: CITY: STATE: ZIP:
MICHAEL AND MAUREEN 399 5TH ST ATLANTIC BEACH FL 32233-5345
WALSH
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.
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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: 10/18/2019 1 of 2
i'''',PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER l
SSP'� PLRS19-0196
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CITY OF ATLANTIC BEACH
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800 SEMINOLE ROAD ISSUED: 10/18/2019
,L'; ATLANTIC BEACH. FL 32233 EXPIRES:4/15/2020
TOTAL:$73.00
Issued Date: 10/18/2019 2 of 2
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5825 Fax (904)247-5845 P L R.
JOB ADDRESS: C/ .' 5 74:4 4 I - 0( 9(4
I 'W O• REPLACEMENT INSTALLATIO t'. 1 °0
Project Value$ Q r
TYPE OF P )' . Orr TYPE OF FIXTURE QrY
Bathtub __ Septic Tank&Pit
Clothes Washer Shower.
Dishwasher _.___ Shower Psx,
Drinking Fountain _ Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
I{itchen Sick Vacuum Breakers T'
TrayLaundry Water Connected Appliances _�
Lavatory Water Heater
Other Fixtures - Water Treating System _
RE-PIPE:
TYPE OF FIXTURE QTY TYPE'OF FXXTURA QTY
Bathtub Septic Tank&Pit
Clotktes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
FIQQr Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Stile Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
4ISCi LLANEOUS:
Sewer Replacement a Back Flow Preventer o Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
t Lawn Sprinkler System-Number of Heads a Well **
'SJRWD Well Completion Form_ Completed form to be submitted to the Building Department for final inspection.**
Other
111111111111111111111.11111111.1111.11111.1111W AIIIMIMEMINININIF
tilt becomes void if work does not commence within a sir month period or work is suspended or abandoned for six months.I btreby certify that I have read
s application and know the mac to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether speclncd
cot The permit does not give authority to violate the provisions ofroth7 state or local law regulation construction or the performance of construction.
operty Owners Name CL ce,e l//H/I,�1-t Phone Number 90`I- 65'/- `i,22 y ,
umbing Company Mat 9,417'• PLk i '( Phone it`t q972 k't�x b,0'
W.3
,. Address: 71 T01---VV- a
.,?�'�0 ��] � 3 v� City �� ){ ,statet---C-zip Z Z ZV
cense Holder(Print): /�r��ZC S 1'Ativ.isT� S ate Certification/Registration# 0'C 1,50-5'9.(0
tarized Signature of License Holder lir0
Before me this ( 7 day of 20 //0
Signature of Notary Public .- � .�� . 't.
P•Pu�• DIANE O.ROCHE
:„ MY COMMISSION#GG 117147
_.__.. .. ExPIKES:June 21,2021
Bonded Thru Notary Public Underwriters 1
S%=L'lr
Cash Register Receipt Receipt Number
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�~ City of Atlantic Beach R10777
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DESCRIPTION I ACCOUNT I QTY PAID
PermitTRAK $73.00
PLRS19-0196 Address: 399 5TH ST APN: 169881 0000 $73.00
PLUMBING $69.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 2 $14.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
•
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R10777 $73.00
Date Paid: Friday, October 18, 2019
Paid By: ATLANTIC COAST PLUMBING CORP.
Cashier: CB
Pay Method: CREDIT CARD 1
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Printed: Friday,October 18, 2019 10:01 AM 1 of 1 `