468 Whiting Ln PLRS20-0049 Sewer Replacement (....'"`''"''%,' PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
�� PLRS20-0049
s, CITY OF ATLANTIC BEACH
ISSUED: 3/10/2020
�� 800 SEMINOLE ROAD
01;1}~ ATLANTIC BEACH. FL 32233 EXPIRES: 9/6/2020
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:
468 WHITING LN PLUMBING RESIDENTIAL SEWER REPLACEMENT $1700.00
TYPE OF REAL ESTATE ZONING: I BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171452 0000 ROYAL PALMS UNIT
02A3.00
COMPANY: ADDRESS: CITY: STATE: ZIP:
ATLANTIC COAST 3653 REGENT BOULEVARD, #305 JACKSONVILLE FL 32224
PLUMBING CORP.
OWNER: ADDRESS: , CITY: STATE: ZIP:
HANSEN JESSICA R 468 WHITING LN 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.
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 1 $7.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
Issued Date: 3/10/2020 1 of 2
�Sy�'.0„, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
J k %J PLRS20-0049
.. s, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD ISSUED: 3/10/2020
ov``m a/ ATLANTIC BEACH. FL 32233 EXPIRES: 9/6/2020
TOTAL:$66.00
Issued Date:3/10/2020 2 of 2
PlumbingPermit Application **ALL INFORMATION
pp HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
tf'"'
800 Seminole Rd, Atlantic Beach, FL 32233 PLR ZCD- 0049
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 1-1(08Og(-7-1
• PROJECT VALUE $ /7OO a"
✓iNEW OR REPLACEMENT INSTALLATION and/or ORE-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
D ISCELLANEOUS
Sewer Replacement
❑Back Flow Preventer
❑Lawn Sprinkler System (number of sprinkler heads)
E3rease 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 or local law regulation construction or the performance of construction.
Owner Name: g l&I,4,' Phone Number: LI.'Z Ss?5
Plumbing Company: fra-,(701-e glIffice Phone: .9'97.'271 Fax r'4.5-9.71'e3
Co. Address: ��53 1, L31-07- 5City: State: r-6-Zip: 57-74)
License Holder: /( j c Sia ,Certifi ation/Registration # Ct " 05e59c
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this IC day of G 7- , 20 t in the State of Florida,
County of
�'• DIANE O.ROCHE
��
-: Signature of Notary Public
iNMY COMMISSION#GG 117147
." EXPIRES:June 21,2021
•'••*:t Bonded TbruNotary Public Undervriters [vf"Nersonally Known OR [ J Produced Identification
Type of Identification:
Updated 10/17/18
•
=�'s I� t, Cash Register Receipt Receipt Number
�� City of Atlantic Beach R11951
\01111` V
DESCRIPTION I ACCOUNT I QTY PAID
PermitTRAK $66.00
PLRS20-0049 Address: 468 WHITING LN APN: 171452 0000 $66.00
PLUMBING $62.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 1 $7.00
STATE SURCHARGES $4.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL FEES PAID BY RECEIPT: R11951 $66.00
Date Paid: Tuesday, March 10, 2020
Paid By: ATLANTIC COAST PLUMBING CORP.
Cashier: FJ
Pay Method: CREDIT CARD 3
Printed:Tuesday, March 10,2020 12:45 PM 1 of 1 V