369 10th St PLRS20-0023 plbg permit c
'''" PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
fs PLRS20-0023/
J� CITY OF ATLANTIC BEACH ISSUED: 2 /(�z�
800 SEMINOLE ROAD [[[
`'�J'; We ATLANTIC BEACH. FL 32233 EXPIRES:
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:
INSTALL 17 FIXTURES FOR
369 10TH ST PLUMBING RESIDENTIAL NEW SINGLE FAMILY $10000.00
RESIDENCE
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170086 0000 ATLANTIC BEACH
COMPANY: ADDRESS: CITY: STATE: ZIP:
1 WHITEHEAD PLUMBING 125 DIEGO ISLAND CT ST. AUGUSTINE FL 32095
INC
OWNER: ADDRESS: CITY: STATE: ZIP:
AYERS JOSEPH A&AMY L 369 10TH ST ATLANTIC BEACH FL 32233-5529
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 17 $119.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.61
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
Issued Date: 1 of 2
r
S' vrp PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
-1 ix.0 PLRS20-0023
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED:
`''; ' ATLANTIC BEACH, FL 32233 EXPIRES:
TOTAL:$178.61
Issued Date: 2 of 2
p L-aD- o 03.3 C 't
Plumbing Permit Application **ALL INFORMATION
i—y!r �� HIGHLIGHTED IN
0,'''' #41141
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
'-,1!•,119',- Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: P1-0-3;)
JOB ADDRESS: 360 100 Sigel PROJECT VALUE $ 0( C)OO
4NEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY ��
Bathtub Z Septic Tank& Pit
Clothes Washer I Shower
Dishwasher I Shower Pan 2
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet —4-
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray T Water Connected Appliances
Lavatory t. Water Heater 1
Other Fixtures Water Treating System
❑MISCELLANEOUS
❑ Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler heads)
❑ Grease Interceptor(Trap) gallons (Requires 3 sets of plans)
❑ Well **SIRWD 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 r local law regulation construction or the performance of construction.
Owner Name: fr. Phone Number:
Plumbing Company: ) 1� nVilid1C50ekilf). Office Phone: VO. )
.39 U- i. i ax
Co. Address: VD D116)0 IP ' a - City:9 Alki- Stater Zip: ;i0qc
License Holder: At, .011 Stat..-- ficati Registration # C/t !*L5Ø ?
Notarized Signature of License Holder I t ► l ' - • i
• \
The foregoin instrument was acknowledged before me this S day of ft....*, , 20'4in the State of Florida,
County of at
Signature of Notary Public C-2 \— —
JENNIFER JOHNSTON
Sr‘;‘,..??..‘"_? MY COMMISSION#GG 042984 [ ) Personally Known OR [ I Produced Identification
it' IN4f, *i EXPIRES:October 27,2020 Type of Identification:
"''>,�oPl Bonded T ru Notary Public UnderW1 tere
'so �.• -- Updated 10/17/18