573 AQUATIC DR PLRS25-0068 r
PLUMBING PERMIT APPLICATION FOR INTERNAL OFFICE USE ONLY
'� n //
City of Atlantic Beach Building Department PERMIT# [�t.RS Z S����7e3
-.am 800 Seminole Road, Atlantic Beach, FL 32233 **ALL information required to process
:. Phone: (904)247-5826 Email: Building-DeptPcoab.us
JOB ADDRESS ( U(�1L \ _ PROJECT VALUE $ L#�CXX)
P<EW OR REPLACEMENT INSTALLANTION and/or ❑ RE-PIPE
TYPE OF FIXTURE TYPE OF FIXTURE
Bathtub Quantity / Septic Tank& Pit Quantity
Clothes Washer Quantity Shower Quantity
Dishwasher Quantity ( Shower Pan Quantity /
Drinking Fountain Quantity Slop Sink Quantity
Floor Drain Quantity Three Compartment Sink Quantity
Floor Sink Quantity ^^ Toilet Quantity c2
Hose Bibs Quantity pL Urinal Quantity
Kitchen Sink Quantity ( Vacuum Breakers Quantity 0-
Laundry Tray Quantity Water Connected Appliances Quantity
Lavatory Quantity a Water Heater Quantity /
Other Fixtures Quantity Water Treating System Quantity
❑ MISCELLANEOUS /
❑ Sewer Replacement / Y.'-2)❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler heads)
❑ Grease Interceptor(Trap) gallons (Requires 1 set of digital plans)
❑ Other:
NOTICE:Permit becomes expired if work does not commence within a six month period or work is suspended or abandoned for six
months. 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.
PROPERTY OWNER Name Phone
PLUMBING COMPANY Name4_1Z1QT L, Phone ?L T--�J) "'00/
`,, SN
7
Address l�t1�j S (Q t 9 S �( City ( {'it le State Zip 3Z19G
License Holder .' f1, A i,Lin State Certification# C /42 t6 , Email ci'r--G. rig, 4.7-7.t ?
" lieu of signet,sw. n a d notarized signatures of the property owner, agent and/or contractor,and under penalties of
p•rjury,I declare ha ha a read and examined the foregoing application and that the facts stated in it are true and correct."
41S 1 Al
•:,4 e R PRINT,OR TYPE NAME OF CONTRACTOR DATE
Plum. it Application 02.25.2025
(znsiq
xis s nfritivw
a edit*/kek,
•
os4
br•