1021 ATLANTIC BLVD UNIT 991 PLPP21-0029 ,--- r, PLUMBING COMMERCIAL OR PERMIT NUMBER
r t. 1 PLPP21-0029
, MULTIFAMILY DETAILS PER ISSUED: 9/15/2021
r
�,,,,,. v BUILDING PLAN PERMIT EXPIRES: 3/14/2022
MS'1`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:
1021 ATLANTIC BLVD Unit PLUMBING COMMERCIAL OR
991 MULTIFAMILY DETAILS PER 2 PLUMBING FIXTURES $1000.00
BUILDING PLAN
TYPE OF 1 REAL ESTATE BUILDING USE
I ?
ZONING: SUBDIVISION:
CONSTRUCTION: ! NUMBER: I GROUP:
177602 0040 SECTION LAND
COMPANY: I ADDRESS: ; CITY: STATE: ZIP.
PREMIER PLUMBING, INC 2663 ORKNEY CT ORANGE PARK FL 32065
OWNER: ' ADDRESS: CITY: STATE: ' ZIP:
EQUITY ONE ATLANTIC NORTH MIAMI
1600 NE MIAMI GARDENS DR Fl_ 33179
VILLAGE INC BEACH
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.
Roll off container company must be on City approved list . Container cannot be placed on City right-of-way.
I 1
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
Issued Date:9/15/2021 1 of 2
Plumbing Permit Application **ALL INFORMATION
-: HIGHLIGHTED IN
c- City of Atlantic Beach Building Department GRAY IS REQUIRED.
r 800 Seminole Rd, Atlantic Beach, FL 32233 PLp'-ZV -00z'j
•-r rt 9'' Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:CdrOMZ/-06364
JOB ADDRESS: /C32/ 4J/anjjL ,6/1!' Ute. , PROJECT VALUE $ /MO,(90
111 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 _
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory _l__ Water Heater
*„res f _ Water Treating System
El 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. **
❑ 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.
I. y 1�'
Owner Name: 61U) t Q'!p4
_ -'/a Li'cr 17:1/05,e_. ,y/C... Phone Number:
Plumbing Company: fr.eni,,r f/umb;,zy )1,ic Office Phone: ?Dy-5l0-9(01I Fax
Co. Address:ji/9' D /- &,4i /4✓e. s, uf,1 t- to City: TQC State: FL. Zip: 3‘2.5-5-6.
License Holder: Mari_ Crrbbs State Certification/Registration # (j''G / 130z
c
Notarized Signature of License Holder
The foreg instrument w s acknowledged before me this 1 da .f CJp , 202 (, in the State of Florida,
County oft 0 1tCt,
Signature of Notary Public CDfry 51____
—
AO
[ ] Personally Known OR [ ] Produced Identification
I ',1;i4••; TONI GINDLESPERGER
: = MY COMMISSION#GG 353178 Type of Identification: .1 . __,
. EXPIRES:October 6,2023
:'r�P` Updated 10/17/18
FF,F? Bonded Thru Notary Public Underwriters