487 Royal Palms Dr PLRS21-0132 12 Plumb Fixtures mss'-' PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
st-xQ� � .: PLR521-0132
J�': , .;. ,,_;�, CITY OF ATLANTIC BEACH
~ 800 SEMINOLE ROAD ISSUED: 8/26/2021
..-1-01119%.- v ATLANTIC BEACH, FL 32233 EXPIRES: 2/22/2022
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:
487 ROYAL PALMS DR PLUMBING RESIDENTIAL 12 Plumb Fixtures: ADD $10000.00
BATHROOM AND REMODEL
TYPE OF REAL ESTATE ZONING: BUILDING USE SUBDIVISION:
CONSTRUCTION: NUMBER: GROUP:
171484 0000 ROYAL PALMS UNIT
02A3.00
COMPANY: ADDRESS: CITY: STATE: ZIP:
KDS VENTURES LLC 27184 Murrhee Rd. Hilliard FL 32046
OWNER: ADDRESS: I CITY: STATE: ZIP:
AMANNA SERVICES LLC 487 ROYAL PALMS DR ATLANTIC BEACH FL 32233-3925
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT I(`
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
IRoll 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
i
PLUMBING FIXTURES 455-0000-322-1000 12 $84.00
STATE DBPR SURCHARGE 455-0000-208 0700 0 $2.09
STATE DCA SURCHARGE 455-0000-208 0600 0 $2.00
Issued Date:8/26/2021 1 of 2
^S�` 'y:t \'f'• ,. PLUMBING RESIDENTIAL PERMIT PERMIT NUMBER
� ��,A PLRS21-0132
; CITY OF ATLANTIC BEACH
KYISSUED: 8/26/2021
-Zol'AFr v 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233 EXPIRES: 2/22/2022
TOTAL:$143.09
Issued Date:8/26/2021 2 of 2
Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
rf City of Atlantic Beach Building Department GRAY IS REQUIRED.
v800 Seminole Rd, Atlantic Beach, FL 32233
\<-0;111)., Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT 0: Ri 5oz/ —') ) 7 2-
JOB ADDRESS: 4147 /2e), 1 /6),a/m1-- PROJECT VALUE $ / ‘' 4-1
f NEW OR REPLACEMENT INSTALLATION and/or LIRE-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 2-
Hose Bibs Z Urinal
Kitchen Sink / Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 2- Water Heater _,Z_
Other Fixtures Water Treating System
El MISCELLANEOUS
4.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: , 1 ,vA/.A sz-tViz-a/ ZZ.:C Phone Number:
Plumbing Company: HOS- vc471//c c Lc..-C- Office Phone:9'ev-c '24-3 5123ax
Co. Address))Arr /y21 ' ,'/£f gig City: ,W/1.07",.V State:/"/Zip: 32GOy0
License Holder: `4�,;2•� s---Z`4,/1 State Certification/Registration #�.C'/<2736
Notarized Signature of License Holder /. --- !C-V.---44—
The
' -V.--
The foregoininstrument was acknowledged before me this 2-(p day of /I ubusi , 20 ZI, in the State of Florida,
County of lUVfL
:m CHRISTIAN GILES Signature of Notary Public CM c / Ah
_.,; ••% \*: MYCOMMISSION IHH117153
l _L;•,_:.;f:: EXPIRES:ApA13,2025
' IV Notary ,� [ ] Personally Known OR [LI/Produced Identification
Type of Identification: F-1._ - Di .
Updated 10/17/18