1855 Beach Ave PLRS20-0030 9 Fixtures PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
:11) CITY OF ATLANTIC BEACH PLRS20-0030
- __ ISSUED: 2/18/2020
� 800 SEMINOLE ROAD EXPIRES: 8/16/2020
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:
1855 BEACH AVE PLUMBING RESIDENTIAL RENO - 9 FIXTURES $3000.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169723 1115 THE NAUTILUS
CONDOMINIUM
COMPANY: ADDRESS: CITY: STATE: ZIP:
COGBUN AND 17C Ponte Vedra Ct Ponte Vedra Beach FL 32082
WAKEFIELD PLBG
OWNER: ADDRESS: CITY: STATE: ZIP:
MATHEWS DONNA 3292 FM 1699 AVERY TX 75554
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 9 $63.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $122.00
Issued Date:2/18/2020 1 of 2
ri' '''tr,. PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
rdii.
� CITY OF ATLANTIC BEACH PLRS20-0030
800 SEMINOLE ROAD
ISSUED: 2/18/2020
�``''"'r ATLANTIC BEACH. FL 32233 EXPIRES: 8/16/2020
Issued Date: 2/18/2020 2 of 2
Y =-sir,,, Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
f 3 t 800 Seminole Rd, Atlantic Beach, FL 32233
� ''` P Lids o-003 v
N"=i"r Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: $ 3T 5 RQA/�I �1�, PROJECT VALUE $ ..�3 Do 'v
/
1dNEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer Shower
Dishwasher __I_ Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink o� Vacuum Breakers
Laundry Tray Water Connected Appliances /
Lavatory 3 Water Heater
Other Fixtures Water Treating System
El 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
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: I Y\CA t1A<-1-5 S Phone Number: 9L1 h Zell- 6 320
Plumbing Company: X3 UPS -t-to--L4- Office Phcfle: ?0'1- ?3q- 3gS3Fax
Co. Address: S-7-7° (-1•64p--A- PA—Lk & City: :4-9- State:F Zip: ?-zeyy
License Holder: C:,(n" CO Qkr� State Certification/Registration # C F< ly2''l4O
401/ /
Notarized Signature of License Holder ,-
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The foregoiVstrumen as acknowledged •-fore met '41110 -,
•. of , 20Ln the State of Florida,
County of 0 {
0
Signatur of Notary Publ'c 0' ellikt
�'""° TONI GINDLESPER
;' •""`''�i.. GER ersonally Known OR [ ] Produced Identification
1: ;,: MY COMMISSION#GG 353178
+�F EXPIRES:October 6,2023 Type of Identification:
Gordo ilru h::;ry Palk Umen ritero Updated 10/17/18