1977 Beach Ave PLRS19-0228 14 Fixtures t''21PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS19-0228 I
800 SEMINOLE ROAD
ISSUED: 12/16/2019
r) ATLANTIC BEACH. FL 32233 EXPIRES: 6/13/2020
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:
1977 BEACH AVE PLUMBING RESIDENTIAL PLUMBING - 14 FIXTURES $6000.00
TYPE OF 1 REAL ESTATE ; ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169723 1006 BEACH AVENUE
CONDOMINIUM
COMPANY: ADDRESS: CITY: STATE: ZIP:
WAYNE CONN PLUMBING 6915 W BEAVER ST JACKSONVILLE FL 32254
INC.
OWNER: ADDRESS: CITY: STATE: ZIP:
MARTIN RACHEL 1977 BEACH AVE 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 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 14 $98.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.30
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
Issued Date: 12/16/2019 1 of 2
s"L'fi�, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
o'ti
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CITY OF ATLANTIC BEACH PLRS19-0228
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800 SEMINOLE ROAD ISSUED: 12/16/2019
`"P4�F; �� EXPIRES: 6/13/2020
ATLANTIC BEACH. FL 32233
TOTAL:$157.30
Issued Date: 12/16/2019 2 of 2
PlumbingPermit Application **ALL INFORMATION
pp HIGHLIGHTED IN
s
City of Atlantic Beach Building Department y_RAY IS REQUIRED.
J800 Seminole Rd, Atlantic Beach, FL 32233 P(_i S �c� - oz-
Phone: (904) 247-5826 Email: isuiiding-Dept@coab.us PERMIT#: 5 I g-Gy iS
JOB ADDRESS: `� � �" '� -S 2-2-3 PROJECT VALUE $ [�/ d O
IJVEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer N Shower
Dishwasher I 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
❑Sewer Replacement
['Back Flow Preventer
DLawn Sprinkler System (number of sprinkler h ds)
iarease Interceptor (Trap) gallons (Requires 3 sets of plans)
0 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: k-�the " 1^( f n Phone Number:
Plumbing Company: W c n C. nn w t u ihh," 7q Office Phone: cld'i-3S 3-3/o Fax
Co. Address: (q 15 W z44- g--o)v Pi S�. City: -)�C Le_0,7 State: f--Zip: 32-2...C41
License Holder: U e.- n d n S P^! State Certification/Registration # ( FC/y,cG 9
Notarized Signature of License Holder
The foregoing,linstrument was acknowledged before me this 16 day of i/ec er^- �c: 20 19, in the State of Florida,
1/
County of t
of NotaryPublic
Pvr, Notary Public State of FloridaSignature
Gina M Fowler
yg
p� ExpirMyCesommission10/17/202GG015049 [4ersonally Known OR [ ] Produced Identification
Type of Identification:
Updated 10/17/18