1085 ATLANTIC BLVD 67 PLPP22-0012 Co ? Z- oo7
„,..,, l \ Plumbing Permit Application **ALL INFORMATION
i HIGHLIGHTED IN
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`; City of Atlantic Beach Building Department GRAY IS REQUIRED.
�; ,, 800 Seminole Rd, Atlantic Beach, FL 32233
`XPi; . Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: 1 L P t -zL
JOB ADDRESS: 1085 Atlantic Blvd Jacksonville FL (-WA- 6. 7 PROJECT VALUE $2,300.00 CD C) I Z--
eniEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 1 Septic Tank& Pit
Clothes Washer 1 Shower
Dishwasher 1 Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 1
Hose Bibs 1 Urinal
Kitchen Sink 1 Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 1 Water Heater 1
Other Fixtures Water Treating System
❑MISCELLANEOUS &l
❑Sewer Replacement
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❑Back Flow Preventer
❑Lawn Sprinkler System (number of sprinkler heads)
❑Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
❑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.
Owner Name:NCM LLC ET AL Phone Number: (203)514-1564
Plumbing Company: Floridian Plumbing INC Office Phone: (904)885-7661 Fax _
Co. Address: 2749 Cove View Dr City: Jacksonville State: FL Zip: 32257
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License Holder: Oriola Lukaj State Cer .fic tion/Registration # 6 Ft I L 2,el-i41i
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Notarized Signature of License Holder ��,�..0-�
The foregoing instrum nt was acknowledged before me this <: day of Juv1c , 202.2_, in the State of Florida,
County of -buk/3-�
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..- Cammissun#Hi16815fi Signature of Notary Public
;: .4= Expires August 23,2025
` ,��° Bon/01hnlTroy F Ins+xreu1:00385-7019 �] Personally Known OR [ ] Produced Identification
Type of Identification:
Updated 10/17/18