417 OCEAN BLVD - PLRS20-0026 ' '''`'`' PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
PLRS20-0026CITY OF ATLANTIC BEACH'} \ 800 SEMINOLE ROAD
ISSUED: 2/7/2020-5;2 ATLANTIC BEACH. FL 32233 EXPIRES: 8/5/2020
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: i DESCRIPTION: VALUE OF WORK:
417 OCEAN BLVD PLUMBING RESIDENTIAL SHOWER PAN $400.00
TYPE OF REAL ESTATE ZONING: I BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170162 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
MARCHA PLUMBING 10139 BOOKWOOD FOREST BLVD JACKSONVILLE FL 32225
INC.IN
OWNER: ADDRESS: CITY: STATE: ZIP:
MILO SARA C 417 OCEAN BLVD 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.
-- — -- --71
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 0 $0.00
i
PLUMBING FIXTURES 455-0000-322-1000 1 $7.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
I
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $66.00
Issued Date: 2/7/2020 1 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
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: c7 t , Oeedil /5/frc. PROJECT VALUE $ yDQ, "
❑NEW OR REPLACEMENT INSTALLATION and/or ERE-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 Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
❑MISCELLANEOUS
Sewer Replacement
I 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
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: Sura 712'/o Phone Number: (poy) L – 66r,,‘
Plumbing Company: ' IAICAakd #004/01/ Office Phone: Fax
Co. Address: IC/39 Aso k waete A671 Mid City: [.eSOK1/Se State: F/ Zip: r)-09D5
License Holder: to State Certification/Registration # CfCio5`1395
Notarized Signature of License HolderS--) 94".ive, c7)(Aca
The foregoin instrument was acknowledged before me this 05 day of�bcCCA.1. (, 20 9JJ; in the State of Florida,
County of JV�j('xApurrorbauliworlorremilmOMMINarniftemoie
� lJ
:::...y., LESLIE FEIGHT Signature of NotaryPubli ♦I �^ kfCiLl
Commission 8 GG 319527 g
Expiros August 15,2022
77 PersonallyKnown OR •roduced Identification
•''1��:'.�' Bonded Thru Troy Fein Insurance 800.385.1019 [ J
Type of Identification: Fl _,
Updated 10/17/18