544 ATLANTIC BEACH CT - PLUMBING rr�J`J j :.
. . CITY OF ATLANTIC BEACH
10
f 800 SEMINOLE ROAD
):-, ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-1786
Job Type: PLUMBING ONLY
Description: PLUMBING - 25 FIXTURES
Estimated Value:
Issue Date: 8/5/2016
Expiration Date: 2/1/2017
PROPERTY ADDRESS:
Address: 544 ATLANTIC BEACH CT
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: NELSON PLUMBING CO. INC.
Address: 11624 -1 DAV E DAVIS CREEK RD QA SCOTT GARY
NELSON
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $175.00
Trade Permit Base Fee $55.00
Total Payments: $234.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CI'T'Y OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
r
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233 i / _ (�
Ph(904)247-5826 Fax (904) 247-5845 I (D f -i 7
JOB ADDRESS: 5 /t 4rc,AN'rl C FrftCil e PERMIT# 16- SFr-- I'(51
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 3 Septic Tank&Pit
Clothes Washer _!_ Shower __I__
Dishwasher _L___ Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet __S__
Hose Bibs Urinal
Kitchen Sink _I____ Vacuum Breakers
Laundry Tray Water Connected Appliances 1
Lavatory 6 Water Heater ___E—
Other Fixtures I Water Treating System
RE-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 Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement 0 Back Flow Preventer 0 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads 0 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.rin
Property Owners Name ILiIIEEZS'C 08 WlfS Phone Number
Plumbing Company /VEG5( J PL.u,fl131,I)( �D 'TAX Office Phone iC2 -'Nett Fax
Co. Address: /1 62(fr( D/4'V 1 S (..I[c4 k— go i i ,
$i)6i4 LIE State k zip 32_256
t" / /
License Holder(Print): g _o'T'r' ! V�/EUS to Certification/Registration# 02c)319
Notarized Signature of License Holder P lel(
:g'';;•.. USA P.BASS Before me this ' da ,' _Ai.! , . PJ 20 IV
"�• t:';° Mr COMMISSION t FF 900342 /
,.`., EXPIRES:November 16,2019 / — `
H D,eeE 1h�u Notary Pubic UnOenrrters Signature of Notary Pub I i
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