1021 ATLANTIC BLVD #977 - PLUMBING 'S3Q07 9NKIIIIlg
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CITY OF ATLANTIC BEACH
80O SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
PHONE (904) 247-5855
Cashier Id: aspcust\atlblae
Receipt Date: 4/12/2016
Receipt Number: 0S-69662
Job ID: 16-PLBG-833 - 15 plumb fixtures U
NIT 977 TP - Trade Permit Base Fee $55.0
0
Job ID: 16-PLBG-833 - 15 plumb fixtures U
NIT 977 PDCA - State PLMG DCA Surcharge
$2.00
Job ID: 16-PLBG-833 - 15 plumb fixtures U
NIT 977 PDBPR - State PLMG DBPR Surcharge
$2.00
Job ID: 16-PLBG-833 - 15 plumb fixtures U
NIT 977 PL1 - Plumbing Fixtures $105.00
Amount Due: $164.00
Tender Information: Cash $164.00
Tender Type: CC
Tender Amount: $164.00
Change Due: $0.00
fUUMBING rERmirr APPLICATION
CITY OF ATLANTIC BEACH.
NO Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(9O4).247-545
—ffrisi
JOB ADDRESS: /o a,/ A-/-/an he,. i..id. , Gin d-- 971 PERMTr
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF Emma. en' TYPE or FIXTURE QTY
Bathtub _ _ , Septic Tank&•Pit
Clothes Washer Shower
Dishwasher ShOWey Pan
Drinking Fountain 7 Slop Sink ___
Floor Drain _____ Three Compartment Sink
Floor Sink __1_,_ Toil et .- -
Hose.Bibs
Alt. Urinal
Kitchen Sink Vacuum,Breakers
"----'\\,(.,
Laundry Tray I. Connected Appliances
Lavatory 7-- Water Ileater _..1.....
&rj)
Other Fixtures Water Treating System
RE-PIPE:
TYPE OF FIXTURE QTY. TYPE OP FIXTURE QTY
Bathtub Septic Tank it 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
t avatmy Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
Sewer Replacement o Back Flow Preventer L-:: Grease Interoeptor(Trap) gallons(Requires 3 sets of plans)
7.1 Lawn Sprinkler-System-Number of Heads 0 Well **
**
3jg,W1) Well Completion Form. Completed firm to be Submitted to the.BWiding Department for final ingection.**
te6.---tier . i' / .60nneed-ii, • A ._., _di ' A - i ' e . ',21 1 t)7 , 'ifigfti•c7 I I 141rVE 97 Z 11191 11111 I 0 I r
?errnit,hearties void if Work does not corontmce vvidno a six.month period or work is=speeded or abandoned ftn-six molls,1!lathy certify that I have read
his appticatiort and know the same to ire end oonta All.provisions of laws and ordinances governing this work will be complied with‘411C.ther spacified
r not The pen)*does not Ovc authority to vioialo the provisions of caty other statc or local lal.v regulation constmetion or the porformance of construction.
! ropetty Owners Name R9,44-"tra ./i., Adz Phone Nurnber
A
?Iumbing Comp- ,! /..., U " . i / A". —di ii A , / A
o. Address:4532.Rill,4/At/ ,,,cie 12— City 7j? State --Zip,22e,zy
License liolder(Print)t Lance Maxwell , State C- '.oationfRegistration10 CFC-057415
/
Votarized Signature of License Holder ,ik ak, ,,,i 41 AL. _ , _,
.,jt,-0.s.,kieN min,FavEteasK ora and subscnbed before me this kJ" day of ek>i-‘\ 20\47
to,,.,. Notary PubrtO-State ot Florida — I r I
EL ,T,' 'j My Comm,Expires Jan s 201$ ' natare of Notary Public -irk . ,it he. , - ._.a..1..LL 41rff_ _Ji 1
V.VCea'-.".: COMMiSSioti#if 688973
%.,9.v; s•
LULL 91.03/80/170
L00/1.00 d 12014
•
�sv CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
\0i31 9r
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-833
Job Type: PLUMBING ONLY
Description: 15 plumb fixtures UNIT 977
Estimated Value:
Issue Date: 4/12/2016
Expiration Date: 10/9/2016
PROPERTY ADDRESS:
Address: 1021 ATLANTIC BLVD
RE Number: 177602-0040
PROPERTY OWNER:
Name: EQUITY ONE ATLANTIC VILLAGE,
Address: 16 NE MIAMI GARDENS DR ATTN. TREASURY DEPT
GENERAL CONTRACTOR INFORMATION:
Name: LANCE MAXWELL PLUMBING, INC.
Address: 8604 OLD ORANGE PARK RD QA LANCE EUGENE
MAXWELL
Phone: - -
FEES:
Trade Permit Base Fee $55.00
State PLMG DCA Surcharge $2.00
State PLMG DBPR Surcharge $2.00
Plumbing Fixtures $105.00
Total Payments: $164.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.