1306 Beach Ave PLRS20-0050 11 Fixtures -`' ' PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
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vv.:. p CITY OF ATLANTIC BEACH PLRS20-0050
�rzISSUED: 3/10/2020
800 SEMINOLE ROAD EXPIRES: 9/6/2020
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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:
1306 BEACH AVE PLUMBING RESIDENTIAL PLUMBING — 11 FIXTURES $8600.00
TYPE OF REAL ESTATE ZONING: 1 BUILDING USE I SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171839 0000 MANDALAY
COMPANY: j ADDRESS: I CITY: . STATE: ZIP:
COGBUN AND 17C Ponte Vedra Ct Ponte Vedra Beach FL 32082
WAKEFIELD PLBG
OWNER: ADDRESS: CITY: I STATE: I ZIP:
GREENE FAMILY 1306 BEACH AVE ATLANTIC BEACH FL 32233-5732
REVOCABLE LIVING TRUST
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 11 $77.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$136.00
Issued Date: 3/10/2020 1 of 2
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S"'''•% PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER •
s CITY OF ATLANTIC BEACH PLRS20-0050
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800 SEMINOLE ROAD ISSUED: 3/10/2020
°':iia ATLANTIC BEACH. FL 32233 EXPIRES: 9/6/2020
Issued Date: 3/10/2020 2 of 2
PlumbingPermit Application **ALL INFORMATION
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pr City of Atlantic Beach Building Department GRAY IS REQUIRED.j800 Seminole Rd, Atlantic Beach, FL 32233 p(�SZo---cos 0
�''=``'r Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: I3 tjJ PROJECT VALUE $ i�G�•�
GI'QEW OR REPLACEMENT INSTALLATION and/or ❑RE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 1_ Septic Tank& Pit
Clothes Washer Shower 1
Dishwasher ! Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet a_
Hose Bibs Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray Water Connected Appliances I
Lavatory -3 Water Heater I!
Other Fixtures Water Treating System
III MISCELLANEOUS \V
❑ 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. ci
Owner Name: r-t1N\ ar�eJ- p Phone Number: [ (IS—` ` -7K(,->
Plumbing Company: Cqb v� -- � 2
1A-t( - -e-( A P'"Office?one: qaY' 3 Y-3nS3 Fax
Co. Address: 573a 6v4N4• P City: 2-0 eL State: -Zip: 32-2-`f`'f
License Holder: •`1 b ktn 0_,L). LIP-- State Certification/Registration # C.EcI9Z$HZ3
Notarized Signature of License Holderiiiiiiiv
The foregoin rument w s acknowledg>• before - his of 2n the State of Florida,
County of � yf dAi
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_`- "",,i,=`- Si nature of Notar Publ ��
Ei ',-N1 GIi.DLESPERGER g y
hlv COMMISSION#GG 353178
ersonall Known OR [ ] Produced Identification
EXPIRES:October 6,2023 [ y
(?c,•,,nThruNotary Public Underwrtters Type of Identification:
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Updated 10/17/18