1780 ATLANTIC BEACH DR PLUMBING iy1+`171�,
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
]OB INFORMATION:
lob ID: 15-PLBG-1276
lob Type: PLUMBING ONLY
Description: 18 FIXTURES NEW SERVICE
Estimated Value:
Issue Date: 6/1/2015
Expiration Date: 11/28/2015
PROPERTY ADDRESS:
Address: 1780 ATLANTIC BEACH DR
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: DON HARRIS PLUMBING CO..INC.
Address: PO BOX 14668 QA NELSON D. HARRIS
Phone: -
FEES:
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $126.00
Trade Permit Base Fee $55.00
State PLMG DBPR Surcharge $2.00
Total Payments: $185.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904) 247-5826 m:(91104)247-5845 c/
I) 747Z�2�JOB ADDRESS: U _ PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value 5710
TYPE of FIXTURE QTY TYPEOFFWuRE QTY
Bathtub 3 Septic Tank&Pit
Clothes Washer T 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 Water Heater
Other Fixtures Water Treating System
RE-PIPE:
TYPE of FIXTURE QTY TYPE oFF7XTURE 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 Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well **
**&IRWD 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 thin I have read
this application and know the same m 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/m viol a the provis ns of any other state or local law regulation construction or ormance of co sMI .
Property Owners Name! Phone Nth
Plumbing Company D/o�n�Has Plumbing Con., Inc. Office � 44 17 Z,39
Co. Address: city "ate zi 3 222
License Holder(Print): 1✓dpi L- te Certification/Registration
Notarized Signature ojLicense Holder
Sworn and subJSSI-subs ' e e tis da of�u^Iie- 20 5
,�Q"iRn;7:.• KIM BUTLER y
is "1 Commission1l FF 03070.9
�+. z ExWes0dohx25,2o17 Signature of Notary Public
P.c., ama.am.rmv�x.nmmo>s.mu