2139 Seminole Rd PLRS21-0072 5 Fixtures i"'f PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
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PLRS21-0072
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r CITY OF ATLANTIC BEACH ISSUED: 4/29/2021
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800 SEMINOLE ROAD
<:kr.31}r ATLANTIC BEACH, FL 32233 EXPIRES: 10/26/2021 j
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:
2139 SEMINOLE RD PLUMBING RESIDENTIAL PLUMBING - 5 FIXTURES $1500.00
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
169515 0500 SECTION LAND
COMPANY: ADDRESS: CITY: STATE: ZIP:
STYLES SMITH PLUMBING, JACKSONVILLE
1537 PENMAN RD SUITE A FL 32250
INC BEACH
OW ADDRESS: CITY: STATE: ZIP:
Camille Adams 2139 SEMINOLE RD ATLANTIC BEACH FL 32233-5921
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 0 $0.00
PLUMBING FIXTURES 455-0000-322-1000 5 $35.00
STATE DBPR SURCHARGE 455-0000-208-0700 0 $2.00
STATE DCA SURCHARGE 455-0000-208-0600 0 $2.00
TOTAL:$94.00
Issued Date:4/29/2021 1 of 2
it' L'riv PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
t
CITY OF ATLANTIC BEACH PLRS21-0072
6� 800 SEMINOLE ROAD ISSUED: 4/29/2021
--tilt > _ ATLANTIC BEACH. FL 32233 EXPIRES: 10/26/2021
issued Date:4/29/2021 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 � —00.7
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: "' / 7 cif21 iY1O Lc: 12-d PROJECT VALUE $ i5CyO
✓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 1
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 2 Water Heater
Other Fixtures Water Treating System
L I VIISCELLANEOUS
❑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. **
❑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: /?f17i/J0.., 4 /)1S' Phone Number: 6-2l>-32.-0 63b
Plumbing Company: ,3m--6--) Ou ')v4 I YA' Office Phone: OL)) L113) Fax
Co. Address: I5' 7 f etVfACt_C iZc City:Je' G\Vi'IIE' 8cC0I State: +-t--Zip: 32_z-5-e)
License Holder: ._5[--dies it-k State Certification/Registration#(' (✓[�� 1p 'Z
Notarized Signature of License Holder ji
The foregoing instrument was acknowledged before me this ith day of l t e- l , 20 Zl, in the State of Florida,
County of [)t u
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