545 Atlantic beach Ct plbg permit ?S�Ily
�3 I, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J -- ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
TOB INFORMATION:
Job ID: 16-PLBG-2871
Job Type: PLUMBING ONLY
Description: ELECTRIC - 25 FIXTURES
Estimated Value:
Issue Date: 12/27/2016
Expiration Date: 6/25/2017
PROPERTY ADDRESS:
Address: 545 ATLANTIC BEACH CT
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: DARLEYS PLUMBING INC.
CFC056702
Address: 4472 PHILLIPS HWY QA CARL LESLIE DARLEY
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: $234.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax (904)247-5845 1 Ca -PL6G -7-v7 j
JOB ADDRESS: 5f A7,A-ate I)Ant Cf PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPEOFF)XWRE QTY TYPE oFFD rORE QTY -
Bathtub Z Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan --
Drinking Fountain Slop Sink
Floor Dram Three Compartment Sink _
Floor Sink Toilet -�---
Hose Bibs
Urinal
Kitchen Sink 1 Vacuum Breakers
laundryTray Water Connected Appliances T_
Lavatory Water Heater
Other Fixtures �_ Water Treating System
RE-PIPE: v
TYPEOFftavRE QTY TYPEOFF)XTuRE QTY
Bathtub Septic Tank&Pit
Clothes WasherShower —
Dishwasher Shower Pan
Drinking Fountain Slop Sink —
Floor Dram Three Compartment Sink
Floor Sink _, Toilet
Hose Bibs Urinal —
Kitchen Sink Vacuum Breakers
Laundry Trey Water Connected Appliances —
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 eats of 11)808)
❑ Lawn Sprinkler System-Number of Heads
❑ Well '*
**S7RWD Well Completion Form.Completed form to be submitted to the Buil&g Department for final inspection.**
❑ Other
Pwmh li coma void n work soon,
not commence within ma sue moron penod or work rs suspea n or abandoned for be c I hereby
tlwtIn rad
this application and know the same to be true and wrrect All provisions of laws and ordinances governing this work will be complied with whether specified
or not The permit does not give authority w violate the provisions of any other state or local law regulation wnslmction or the performance of constmdion.
Property Owners Name Ow /?^-'S Phone Number
Plumbing Company Q. • Offi phone1'4,a-4 ���" Fax B
Co. Address: city dsaL]pwveState -Zip Q'
License Holder(Print): State CertiScation/Regig"Ition# ('Fi2
Notarized Signature 0 Lieacae Hokin
l2-4 da of Q�c.:...)%s- 20-1(-
JOANNE
016
JO*NNE MENL Sworn andsubscribed beforee this day
of
Wary pualic-slab a/Florw
commlaabn a cc 0212at Signature of Notary Public
(IWE My Comm.Eapna Auo 29.2020 �1
°' BonOea lMou00 NZWON 11Ars,.