775 Plaza PLRS20-0114OWNER:ADDRESS:CITY:STATE:ZIP:
WALLER TRACY 775 PLAZA ATLANTIC BEACH FL 32233
COMPANY:ADDRESS:CITY:STATE:ZIP:
AMELIA PLUMBING 2232 FLORIDA BLVD NEPTUNE BEACH FL 32266
TYPE OF
CONSTRUCTION:
REAL ESTATE
NUMBER:ZONING:BUILDING USE
GROUP:SUBDIVISION:
171118 0000 ROYAL PALMS UNIT 01
JOB ADDRESS:PERMIT TYPE:DESCRIPTION: VALUE OF WORK:
775 PLAZA PLUMBING RESIDENTIAL PLUMBING REMODEL - 4
FIXTURES $2499.00
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 4 $28.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL: $87.00
LIST OF CONDITIONS
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
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.
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.
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.
1 of 2Issued Date: 8/12/2020
PERMIT NUMBER
PLRS20-0114
ISSUED: 8/12/2020
EXPIRES: 2/8/2021
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
2 of 2Issued Date: 8/12/2020
PERMIT NUMBER
PLRS20-0114
ISSUED: 8/12/2020
EXPIRES: 2/8/2021
PLUMBING RESIDENTIAL PERMIT
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
DESCRIPTION ACCOUNT QTY PAID
PermitTRAK $87.00
PLRS20-0114 Address: 775 PLAZA APN: 171118 0000 $87.00
PLUMBING $83.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 4 $28.00
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: R12758 $87.00
Printed: Wednesday, August 12, 2020 1:05 PM
Date Paid: Wednesday, August 12, 2020
Paid By: AMELIA PLUMBING
Pay Method: CREDIT CARD 352703425
1 of 1
Cashier: CG
Cash Register Receipt
City of Atlantic Beach
Receipt Number
R12758
Plumbing Permit Application ALL INFORMATION
f HIGHLIGHTED IN
1 City of Atlantic Beach Building Department GRAY IS REQUIRED.
1 800 Seminole Rd, Atlantic Beach, FL 32233 PL RS Z0-0114-
ss:t> Phone: (904) 247-5826 Email: Buildinv-De_pt@coab.us PERMIT#: RE32-CJ-0tc
JOB ADDRESS: —1t 6 Z PROJECT VALUE $ q qo
IEW OR REPLACEMENT INSTALLATION andjor ERE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer Shower f
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry TrayWater Connected Appliances
Lavatory a Water Heater
Other Fixtures Water Treating System
OVIISCELLANEOUS
DSewer Replacement
Back Flow Preventer
D Lawn Sprinkler System (number of sprinkler heads)
Grease interceptor (Trap) gallons (Requires 3 sets of plans)
ID Well **SJRWD Well Completion Form. Completed fora to be submitted to the Building Department for final inspection. **
QOther
a_..
Permit becomes void if work does riot 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.
7
Owner Name: raC VJ I l\ ex-Number: I
Q — r
Piurribing Company: A-r)nt \\ &1. YtL)kXY'j2I fl Office Phone: I o Fax cj1 J3LS
Co. Address: PD. j?yoX f ' _. City: 1 ! I (.tAtate: fL Zip: -J "t-'D__
License Holder: _ .ILg1ar f-.L_ }O I State Certification/*-gid :pion #
Notarized Signature of LicenseHolder
The foregoing instrument was acknowledged before me this day of 20 , in the State of Florida,
County of
oi\CLA P L U wA
Signature of Notary Public
Personally Known OR [ ] Produced Identification
Type of Identification:
Updated 10/17/18