870 Seminole PLRS21-0021 2 , PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
/�ft.
PLRS21-0021
v� CITY OF ATLANTIC BEACH ISSUED: 2/8/2021
y' 800 SEMINOLE ROAD
�O';"`/ ATLANTIC BEACH. FL 32233 EXPIRES: 8/7/2021
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:
870 SEMINOLE RD PLUMBING RESIDENTIAL PLUMBING - 2 PLUMBING $870.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: ' NUMBER: GROUP:
171968 0000 SELVA MARINA UNIT 03
COMPANY: ADDRESS: CITY: STATE: ZIP:
ADVANTAGE PLUMBING 880 MAYPORT RD JACKSONVILLE FL 32240
BEACH
OWNER: ADDRESS: i CITY: STATE: ZIP:
BUKOWSKI CHRISTOPHER 870 SEMINOLE RD ATLANTIC BEACH FL 32233-5446
MICHAEL
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT If\
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.
FEES
DESCRIPTION ACCOUNT QUANTITY PAID AMOUNT
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 2 $14.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$73.00
Issued Date:2/8/2021 1 of 2
.1!.. ./r%: PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
CITY OF ATLANTIC BEACH PLRS21-0021
800 SEMINOLE ROAD ISSUED: 2/8/2021
":J;1j9r EXPIRES: 8/7/2021
ATLANTIC BEACH, FL 32233
Issued Date:2/8/2021 2 of 2
Plumbing- , Permit Application **ALL INFORMATION
` \ �� HIGHLIGHTED IN
Imp
City of Atlantic Beach Building Department GRAY IS REQUIRED.
'"r 800 Seminole Rd, Atlantic Beach, FL 32233
'-=__•Eni 9f"
� PI-1�Sz-0602
Phone: (904) 247-5826 Email:� Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 70 Se �)$fJ(e. c, PROJECT VALUE $ cc 70, 42
✓a1IEW 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 i
Other Fixtures Water Treating System
LVIISCELLANEOUS
❑Sewer Replacement
DBack Flow Preventer
❑Lawn Sprinkler System (number of sprinkler heads)
D3rease 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.
Owner Name: L 1 RI 5 g ti)0144')7 1 Phone Number:
Plumbing Company: /90 4N l 9L-r ,D/bil,i3/+Office Phone: ,V?' 964f Fax,2C// - %
Co. Address: (> /4A f42i 1 City: A 9, State:3Z4VZip: 322 j
License Holder: ' ( /7 'C' F Sta Certification/Registration # C// / .‘,239S"9
Notarized Signature of License Holderoe L,f,4a
The foregoi g i trumentas acknowledged befor- e this da • r 20Z 1. the State of Florida,
County of u/0_/
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\ jI \ JPerSOnaIIVKnOWnOR
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( ] Produced Identification
Type of Identification:
Updated 10/17/18