475 Skate Rd PLRS20-0173 3 Fixtures PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
' CITY OF ATLANTIC BEACH PLRS20-0173
800 SEMINOLE ROAD ISSUED: 12/4/2020
,
ATLANTIC BEACH. FL 32233 EXPIRES: 6/2/2021
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
hat 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 SKATE RD PLUMBING RESIDENTIAL re—pipe 3 fixtures $2000.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171521 0000 ROYAL PALMS UNIT
02A3.00
COMPANY: ADDRESS: CITY: STATE: ZIP:
TDG PLUMBING 4426 LOYS DR JACKSONVILLE FL 32246
OWNER: ADDRESS: CITY: STATE: ZIP:
LANDRY PROPERTIES LLC 603 15TH ST N JACKSONVILLE FL 32250
BEACH
NARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT Ifs
'OUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT
OUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU
NTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
tECORDING YOUR NOTICE OF COMMENCEMENT.
LIST OF CONDITIONS
toll 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 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: 12/4/2020 1 of 2
51.=L11'/., PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
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r .a" . CITY OF ATLANTIC BEACH PLRS20-0173
D''V z 800 SEMINOLE ROAD ISSUED: 12/4/2020
-"2.9139'' ATLANTIC BEACH. FL 32233 EXPIRES: 6/2/2021
Issued Date:12/4/2020 2 of 2
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Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
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City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 ' e
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: r( Ca
D`D 1 t'3
JOB ADDRESS: L-j1 S S IzzAqk.. QcS PROJECT VALUE $ a,00°- c O
❑NEW 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
❑MISCELLANEOUS
❑ 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. **
Li 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: Li,' Ate. o`?AC- Phone Number:
Plumbing Company:-Tb ro QL,_.r-b 1 NI Office Phone: c off'-514.54-M9 Fax S'Gy-11:513'
Co. Address: lit-k 1, l,oy'J Z Ci- City:Z--"q1F State:FL Zip: -12-2:-.11.
License Holder:Ci / (L.14.J; Q GA1:•evel State Certification/Registration # c-F .-(Li z-70(..-7—
.
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this 3 day of p L(,.Livit4,, 20c in the State of Florida,
County of 17vti/ck\
Signature of Notary Public C\----`—'
STON
Vit'"a MY COMMISSIOENNIFER N HH 057579
;.: :•_. [ ersonally Known OR [ ] Produced Identification
:x%_io EXPIRES:October 27,2024 Type of Identification:
' olF;or: Bonded Thu Notary Pubic Undennilers
Updated 10/17/18