475 Palmwood Ln PLRS20-0034 21 Fixtures .,,Ant,,,,, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
iti \ CITY OF ATLANTIC BEACH PLRS20-0034
800 SEMINOLE ROAD ISSUED: 2/21/2020
01119'' ATLANTIC BEACH. FL 32233 EXPIRES: 8/19/2020
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:
475 PALMWOOD LN PLUMBING RESIDENTIAL PLUMBING - 21 FIXTURES $24000.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
172020 0194 SELVA MARINA UNIT 06
COMPANY: ADDRESS: CITY: STATE: ZIP:
KELLEY'S PLUMBING
CONTRACTING 3866 VALENCIA RD JACKSONVILLE FL 32205
OWNER: ADDRESS: CITY: STATE: ZIP:
JOHN DODSON 475 PALMWOOD LN ATLANTIC BEACH FL 32233-5607
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 0 $0.00
PLUMBING FIXTURES 455-0000-322-1000 21 $147.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.03
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.02
TOTAL: $207.05
Issued Date: 2/21/2020 1 of 2
i'I.Ali„,,, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
JSr 'i,1
CITY OF800SEMINOLE ATLANTICROAD
BEACH PLRS20-0034
'' z ISSUED: 2/21/2020
1119r ATLANTIC BEACH, FL 32233 EXPIRES: 8/19/2020
Issued Date: 2/21/2020 2 of 2
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L. ,, PlumbingPermit Application **ALL INFORMATION
�, -Lr,,., �� HIGHLIGHTED IN
ittr City of Atlantic Beach Building Department GRAY IS REQUIRED.
'' 800 Seminole Rd, Atlantic Beach, FL 32233 p( I` ucJU �-
``''''r Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: Ll7 PAI-P1 IA/
�' LA/ PROJECT VALUE $\ Qiii PrD cc,..
I
1JNEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub i ' Septic Tank & Pit
Clothes Washer j Shower j
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet zi
Hose Bibs Urinal /
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory gf
-T--
Water Heater _L.__
Other Fixtures Water Treating System /
111 MISCELLANEOUS -1,:
/'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 t e Building Department for final inspection.**
❑ Other 061=
:, -=-- T.---- .. _ -- /, -:. _L. 7,1
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: cti 'S ` .k4 ,,tr (�,:xtu(v Office Phone: °ey 3S 2-276)' Fax
Co. Address: 3yLpLe va,v,1N;A,C.--7 City: 6)4 State: N., Zip: 3ZZ0S
License Holder: Nfl(j.tJe - -+/Q.,J 1 't/ // State Certification/Registration# 2rrlIOh7' 0
Z�. (//
Notarized Signature of License Holder "" ��
The foregainkinstrumerl was acknowledged before me this ,Z day L b , 20 Qn the State of Florida,
County ofv t( c._ f
\_ Y`\
J 1 / i
Signature of Notary Public .(-
[ ] Personally Known OR [ ] Produced Identification —
Type of Identification: r j L.—
,
Updated10/17/18
l0fj
J rsp. V ,s, Cash Register Receipt Receipt Number
si
-).101... . City of Atlantic Beach
R11797
r/
DESCRIPTION I ACCOUNT I QTY PAID
PermitTRAK $207.05
PLRS20-0034 Address: 475 PALMWOOD LN APN: 172020 0194 $207.05
PLUMBING $202.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 21 $147.00
STATE SURCHARGES $5.05
STATE DBPR SURCHARGE 455-0000-208-0700 0 $3.03
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.02
TOTAL FEES PAID BY RECEIPT: R11797 $207.05
Date Paid: Friday, February 21, 2020
Paid By: KELLEY'S PLUMBING CONTRACTING
Cashier: CT
Pay Method: CREDIT CARD 11
Printed:Friday, February 21,2020 2:59 PM 1 of 1 IF