1969 W Sevilla Blvd PLRS20-0022 2 Fixtures S..APJtic, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
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\ '" CITY OF ATLANTIC BEACH PLRS20-0022
�r ISSUED: 2/5/2020
800 SEMINOLE ROAD
N.-Pii19%' ATLANTIC BEACH. FL 32233 EXPIRES: 8/3/2020
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:
1969 W SEVILLA BLVD PLUMBING RESIDENTIAL PLUMBING - 2 FIXTURES $2500.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169462 0370 SEVILLA GARDENS UNIT
02
COMPANY: ADDRESS: CITY: STATE: ZIP:
TDG PLUMBING 4426 LOYS DR JACKSONVILLE FL 32246
OWNER: ADDRESS: CITY: STATE: I ZIP:
KOSUTJANETTE ET AL 1969 SEVILLA BLVD W ATLANTIC BEACH FL 32233-4578
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 2 $14.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $73.00
Issued Date: 2/5/2020 1 of 2
(;-:,1...to-,---,,, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
� PLRS20-0022
�, CITY OF ATLANTIC BEACH
'� �� ISSUED: 2/5/2020
800 SEMINOLE ROAD
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��'; ATLANTIC BEACH. FL 32233EXPIRES: 8/3/2020
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Issued Date: 2/5/2020 2 of 2
• PlumbingPermit Application **ALL INFORMATION
•�' jT`! �� HIGHLIGHTED IN
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City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 PL RS Lc)--(DOZz
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:.2 o^`gyp°(
JOB ADDRESS: t9 61 Se J t. O\.)6 LJ e,) PROJECT VALUE $ 2 S'OO �Z
❑NEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer _L__ Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray 1 Water Connected Appliances
Lavatory //_ Water Heater
Other Fixtures / Water Treating System
MISCELLANEOUS
111
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❑ 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.**
E 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: Phone Number:
Plumbing Company:M1) V'L ..' 1 Office Phone: l�y:S1{5.-- nHI Fax 5'0"1 ' $
Co. Address: -k'k \-e'•6 City: -Z—Pif State: Ft. Zip: --S-2:2.43..
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License Holder: (Z.Av Z, Ce,A►:iNet State Certification/Registration # Cf'G-l4i-7.ocz.
Notarized Signature of License Holder_ 6da
The foregoi �nstrument as acknowledged before me this of I , 20 Z • the State of Florida,
County of L AD fma
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Signature of Notary Public - i---�
Personally Known OR [ ] Produced Identification
TONI GINDLESPERGER Type of Identification:
•
1.,1 MY COMMISSION/0 GG 353178 Updated 10/17/18
',' ��.�o`. EXPIRES:October 6,2023
',o,,r.%;,,,, Bonded Thu Notary%bac Undenniters