360 1st St PLRS19-0207 One Fixture PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
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- CITY OF ATLANTIC BEACH PLRS19-0207
800 SEMINOLE ROAD _ISSUED: 11/4/2019
ATLANTIC BEACH. FL 32233 EXPIRES: 5/2/2020
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:
360 1ST ST PLUMBING RESIDENTIAL PLUMBING - ONE FIXTURE $950.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169750 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
STYLES SMITH PLUMBING 1537 PENMAN RD SUITE A JACKSONVILLE FL 32250
BEACH
OWNER: ADDRESS: CITY: STATE: ZIP:
DAVID W NEWMAN
REVOCABLE TRUST 360 1ST ST ATLANTIC BEACH FL 32233-5347
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 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: 11/4/2019 1 of 2
�,s�L`',y,, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
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l4 �� CITY OF ATLANTIC BEACH PLRS19-0207
�d "�" ISSUED: 11/4/2019
800 SEMINOLE ROAD
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9%' ATLANTIC BEACH. FL 32233 EXPIRES: 5/2/2020
TOTAL:$66.00
Issued Date: 11/4/2019 2 of 2
Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
"- City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 P Li, �] "� I- --0Z 7
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: ! / c- 031 G
JOB ADDRESS: 36, D 1 PROJECT VALUE$ 9 9-0, 60
111 NEW OR REPLACEMENT INSTALLATION and/or EIRE-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
Hose Bibs Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
❑MISCELLANEOUS
❑ Sewer Replacement
❑ 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 KA e e. W(,)) fnk PIo-f GI SS)cv) /11)% r ,7 fo
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 L
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: hw, W 4/ )/ ,i Phone Number:
Plumbing Company: ,�j-�//-6 9A1 t� NfrAur"9l Office Phone: ,97 1) -61/31 Fax
Co. Address: /5,3 7 Pe,iAlm id. City: 7e ( 13eAGk, State: I 2. Zip: .3Ac 56
License Holder: s lejState Certification/Registration# CPG / -R Sada
Notarized Signature of License Holder
The foregoi 'nstrument w s acknowledged before me this I ay o k. , 20 ( , n the State of Florida,
County of t
Signature of Notary Pu ) 4�
%..' TONIGINDLESPERGER [ ersonally Known OR [ I Produced Identification
MY COMMISSION#GG353178 _ ype of Identification:
EXPIRES:October 6,2023
‘'•pFfW Bonded Thru Notary Public Undwaitars Updated 10/17/18
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