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1021 ATL BLVD PLBG SS' CITY OF ATLANTIC BEACH J 800 SEMINOLE ROAD ATLANTIC BEACH, FL 32233 ��Jlil>f: INSPECTION PHONE LINE 247-5814 PLUMBING PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 14-PLBG-664 Job Type: PLUMBING ONLY Description: 7 FIXTURES (SEWER) Estimated Value: Issue Date: 12/16/2014 Expiration Date: 6/14/2015 PROPERTY ADDRESS: Address: 1021 ATLANTIC BLVD MAIN RE Number: None GENERAL CONTRACTOR INFORMATION: Name: MCKENDREE PLBG & HTG (PLBG Address: 4248 LENOX AVE QA CLIFFORD FOSTER MCKENDREE Phone: - - FEES: State PLMG DBPR Surcharge $2.00 State PLMG DCA Surcharge $2.00 Plumbing Fixtures $49.00 Trade Permit Base Fee $55.00 Total Payments: $108.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL BUILDING CODES. CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph (904) 247-5826 Fax (904) 247-5845 .TOB ADDRESS: 1021 A T LpNTiC 13L.vd, S�iTr D 3 PERMIT# /77bo1-ooh NEW OR REPLACEMENT INSTALLATION: Project Value$ TYPE OF FIXTURE QTY TYPE OF FIXTURE Bathtub QTY Clothes Washer Septic Tank&Pit Dishwasher Shower Drinking Fountain Shower Pan Floor Drain Slop Sink Floor Sink Three Compartment Sink Hose Bibs Toilet Kitchen Sink Urinal Laundry Tray Vacuum Breakers Lavatory — Water Connected Appliances Other Fixtures Water Heater Water Treating System RE-PIPE: TYPE OF FIXTURE QTY TYPE OF FIXTURE Bathtub QTY Clothes Washer Septic Tank&Pit Dishwasher Shower Drinking Fountain Shower Pan Floor Drain Slop Sink Floor Sink Three Compartment Sink Hose Bibs Toilet Kitchen Sink Urinal Laundry Tray Vacuum Breakers Lavatory Water Connected Appliances Other Fixtures Water Heater Water Treating System MISCELLANEOUS: ewer Replacement ❑ Back Flow Preventer ease Interceptor(Trap) gallons(Requires 3 sets of plans) ❑ Lawn Sprinkler System-Number of Heads ❑ 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. Property Owners Name 6C0ui/y pNF 471^po1114 14. Plumbing Company MPhone Number c.,FNdaE�s P�K„�,�',, �� Li .Office Phone YMS'_387 t-464ax Co. Address: 4,Z 4 p� (,ew /t1ti City�4-A Stater& Zip 31Z� License Holder (Print): C[i�►c.( �'• /VJ�J�� „�.. t,i rr� State Certification/Registratior��14�`�� `j�1,3 Notarized Signature of License Holder (� `��``QQ�. MSS ,•.. 0'-A' c� ber 1 �o•••��. Sworn and subscribed befo e this � ay of �- Signature of Notary Public -6 #MaaM •' •• w 1rSt A im� ��