390 Main St PLRS20-0010 4 Fixtures ,,,51..m,,--,-;_., PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
'. °'\ PLRS20-0010
)i CITY OF ATLANTIC BEACH ISSUED: 1/28/2020
800 SEMINOLE ROAD
o;ll�� EXPIRES: 7/26/2020
ATLANTIC BEACH. FL 32233
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:
390 MAIN ST PLUMBING RESIDENTIAL PLUMBING -4 FIXTURES $1600.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170900 0600 ATLANTIC BEACH SEC H
COMPANY: ADDRESS: CITY: STATE: ZIP:
OWNER: ADDRESS: CITY: STATE: ZIP:
WEST GROUP
ACQUISITIONS LLC 623 MAIN ST ATLANTIC BEACH FL 32233-2530
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.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 4 $28.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.90
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
WORK WITHOUT PERMIT 455-0000-322-1000 0 $110.00
TOTAL: $197.90
Issued Date: 1/28/2020 1 of 2
PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
PLRS20-0010
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 1/28/2020
ATLANTIC BEACH. FL 32233 EXPIRES: 7/26/2020
Issued Date: 1/28/2020 2 of 2
t L'i Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
f' 800 Seminole Rd, Atlantic Beach, FL 32233
--bp'tr Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS:i390 Main St Atlantic Beach Fl 32233 '= PROJECT VALUE$':`x600.00
'MEW 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
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink 3 Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater 1
Other Fixtures Water Treating System
❑MISCELLANEOUS
❑Sewer Replacement
❑Back Flow Preventer
❑lawn Sprinkler System (number of sprinkler heads)
D3rease 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
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:Pest Group Acquisitions LLC Kp @ rft( -X : orge
Phone Number: it ; � w,S
Plumbing Company: .Xtreire Plumbing - Office Phone:x(904)93O:2 936:0‘68"MitiV, Fax
Co.Address: `653.Powers; a lite 6 City: Jacksonville , , , ?{State: li _,Zip: 32217;;
License Holder: Heath Thomas State Certification/Registration# -1596496 'n, ^
Notarized Signature of License Holder fir`
The foregoing instrument was acknowledged before me this 23 day of January , 20 20 , in the State of Florida,
County of Duval
Signature of Notary Public. _42.1/ -
.: •,,� Notary Public stabs of Florida
Teresa L.Dutton [x] Personally Known OR [ ] Produced Identification
:'�{ tdy Commason GG 358713 0 Exves 11/16/2029 Type of Identification:
f
„ .� Updated 10/17/18
\� ) ° **ALL INFORMATION
Plumbing Permit Application �1 HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
PLaszo-001 b
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 390 Main St Atlantic Beach Fl 32233 PROJECT VALUE $ 1,600.00
[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
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink 3 Vacuum Breakers
Laundry Tray -� Water Connected Appliances
Lavatory \ Water Heater 1
Other Fixtures / 1 Water Treating System
❑VIISCELLANEOUS
❑Sewer Replacement
❑Back Flow Preventer
❑Lawn Sprinkler System (number of sprinkler heads)
Lrease 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
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:West Group Acquisitions LLC Phone Number: (904)533-8015
Plumbing Company: Xtreme PlumbingOffice Phone: (904)930-2153 Fax
Co. Address: 6653 Powers Ave Suite 6 City: Jacksonville State: Fl Zip: 32217
License Holder: Heath Thomas taCete' rtification/Regis # 47-1596496
,
Notarized Signature of License Holder
The foregoing instrument was acknowledged before m this 23 day of January , 20 20 , in the State f Florida,
County of Duval
Sign ure of Notary Public
Personally Known OR [ ] Produced Identification
T e_pf Identification:
Updated 10/17/18
rS 1��\ill�,
i„ Cash Register Receipt Receipt Number
:Pip
City of Atlantic Beach R11576
DESCRIPTION I ACCOUNT I QTY PAID
PermitTRAK $197.90
PLRS20-0010 Address: 390 MAIN ST APN: 170900 0600 $197.90
PLUMBING $83.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 4 $28.00
STATE SURCHARGES $4.90
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.90
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
WORK WITHOUT PERMIT $110.00
WORK WITHOUT PERMIT 455-0000-322-1000 0 $110.00
TOTAL FEES PAID BY RECEIPT: R11576 $197.90
Date Paid: Tuesday, January 28, 2020
Paid By: WEST GROUP ACQUISITIONS LLC
Cashier: CT
Pay Method: CREDIT CARD 12
ite
Printed:Tuesday,January 28, 2020 4:30 PM 1 of 1 iii