128 Pine St PLRS20-0170 3 Fixtures :~s'yL , PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
JS ''1 •
- 's,
C.
CITY OF ATLANTIC BEACH PLRS20-0170
.V v~ 800 SEMINOLE ROAD ISSUED: 11/25/2020
x o';1`''- ATLANTIC BEACH. FL 32233 EXPIRES: 5/24/2021
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:
128 PINE ST PLUMBING RESIDENTIAL replace 3 fixtures $400.00
TYPE OF REAL ESTATE ZONING: BUILDING USE 1SUBDIVISION:
. CONSTRUCTION: NUMBER: GROUP:
170633 0000 SALTAIR SEC 03
COMPANY: ADDRESS: CITY: STATE: ZIP:
COUF PLUMBING LARRY 6110-7 POWERS AVE JACKSONVILLE FL 32217
COUF
OWNER: ADDRESS: CITY: ) STATE: ZIP:
SULLIVAN WILLIAM G 128 PINE ST 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.
I
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 3 $21.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$80.00
Issued Date: 11/25/2020 1 of 2
�r' ''',,, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
- , � �`;\
- �
CITY OF ATLANTIC BEACH PLRS20-0170
J t 800 SEMINOLE ROAD ISSUED: 11/25/2020
EXPIRES: 5/24/2021
°iS1� ATLANTIC BEACH. FL 32233
Issued Date: 11/25/2020 2 of 2
Plumbing Permit Application **ALL INFORMATION
' /". HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 pp
_9', Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: fLF5 O-0 IV)
JOB ADDRESS: O R •7c ? i--- PROJECT VALUE $ I-1GC
❑NEW OR REPLACEMENT INSTALLATION and/or III RE-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 I
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory ) Water Heater
Other Fixtures Water Treating System
Li MISCELLANEOUS
❑ Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler heads)
❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
LI 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.
Owner Name: Gar.-71 6.,-f Phone Number: /I,Lf 5941-'33-0?-
Plumbing
94-33`(Plumbing Company: e jf I2/v0412-'t) Office Phone: Fax
Co. Address: (;//0 Pc/w r,-5 ,'HJ( City: 0c-Y State: ri Zip: ?22-17
License Holder: C;t„fry Cc ✓- State Certification/Registration# C ' 1K2,1(41
Notarized Signature of License Holder
The foregoing instrument was acknowledg-• : - -•re rhe thiiss_ / day of 1\1 Q40(pt.(, 20 a-0 in the State of Florida,
County of 1)ULA 1
JENNIFF�tJOHNSTON Signature of Notary Public
le"s my caNMISSION#HH 057519
dendin
_'� EXPIRES:oaober27.2024 [ 1 Personally Known OR [ ro uced Identification
•''•°'" Bonded Trim Notary Pubic� Type of Identification: FL N.,(`•`J Q-N` S L C,t itSk
Updated 10/17/18
Cash Register Rece1=0-1ipt Receipt Number
'IL City of Atlantic Beach R14222
PermitTRAK $80.00
PLRS20-0170 Address: 128 PINE ST APN: 170633 0000 $80.00
PLUMBING $76.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 3 $21.00
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:R14222b
$80.00
Date Paid:Wednesday, November 25, 2020
Paid By: COUF PLUMBING LARRY COUF
Cashier: JJ
Pay Method: EMV 014440 1 398283398
Printed:Wednesday,November 25,2020 12:19 PM 1 of 1 °'4, CENTRALSQUARE