271 Camelia St PLRS21-0039 3 Fixtures , PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
r ► . CITY OF ATLANTIC BEACH PLRS21-0039
- '' ISSUED: 3/4/2021
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233 EXPIRES: 8/31/2021
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:
271 CAMELIA ST PLUMBING RESIDENTIAL PLUMBING - 3 FIXTURES $0.00
TYPE OF REAL ESTATEZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
170866 0315 ATLANTIC BEACH SEC H
COMPANY: ADDRESS: CITY: STATE: ZIP:
AGT Plumbing LLC 1167 Lake Asbury Dr Green Cove Springs FL 32043
OWNER: ADDRESS: CITY: STATE: ZIP:
CONNERS MICHAEL 271 CAMELIA ST ATLANTIC BEACH FL 32233
EDWARD
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.
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:3/4/2021 1 of 2
.-.1I.,:-V1-.3;',,,, PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
j
CITY OF ATLANTIC BEACH PLRS21-0039
800 SEMINOLE ROAD ISSUED: 3/4/20214` If
ATLANTIC BEACH. FL 32233 EXPIRES: 8/31/2021
Issued Date:3/4/2021 2 of 2
ir Plumbing Permit Application **ALL INFORMATION
-T
HIGHLIGHTED IN
' '71 City of Atlantic Beach Building Department GRAY IS REQUIRED.
r�� 800 Seminole Rd, Atlantic Beach, FL 32233 P L RSZ
_ 1,,r I -003
Phone: (904)/�I247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 7 ( l ,1Ary1c I I'm ._.5-1— PROJECT VALUE $ 5 0°
CI NEW OR REPLACEMENT INSTALLATION and/or ERE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower
Dishwasher _1_ Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink —Th Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures I /'\ Water Treating System
ii MISCELLANEOUS j 0)
❑ Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler ads)
❑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. nc(/
Owner Name: m I Cp�L - ' v rJ Phone Number: q S y- , SO /O 'i2.
Plumbing Company: //g-7— `gvi,,b /7 Lc— Office Phone: we.' 5'21-cgo7Fax
Co. Address: f/K7 2A ki> Ashur/ .> City: 4c t Lotx4i _ te: '1 1 Zip: 32O'C
License Holder:Ae•ild, e 7,—:=3/LA _State Certification/Registration # eje fyl,'7S
Notarized Signature of License Holder li"t,� ,fAr,—
The foregoi in ument was acknowledged before me this d. , if aka Ii., _ 20 z,((n the State of Florida,
County of 0'Io—
C/'
Signature of Notary Publi Iraft.,A`,
-----;;,a,..,- _�1 1413tt•1:tt.ESPERGER
:'•-• = �'MMIE91gN#6G 2023 [ ] Personally Known OR [ ) Produced Identification
.•• a.• _.. �Kp1�tE6;Qctober 6,2023
a: Ivy HottaPubnounde 1era Type of Identification: j� L._.
_ _ -- Updated 10/17/18