2325 BEACHCOMBER TR PLRS23-0006 Plumbing Permit Application **ALL INFORMATION
%Sy1`�`' HIGHLIGHTED IN
J City of Atlantic Beach Building Department CGRAY IS REQUIRED.c
800 Seminole Rd, Atlantic Beach, FL 32233
"�r Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: PL 2 >23 -OCX
JOB ADDRESS: 2.3 .5 S hcom be r Trai I PROJECT VALUE $ /5, COO. 00
KNEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub a. Septic Tank& Pit
Clothes Washer _L__ Shower _J_
Dishwasher I Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 3
Hose Bibs 2. Urinal
Kitchen Sink I Vacuum Breakers 2.—
Laundry
Laundry Tray I Water Connected Appliances /
Lavatory a Water Heater I
Other Fixtures / ater Treating System
El MISCELLANEOUS
❑ Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler - . is
❑ 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' _
constr-uction or the performance of construction.
Owner Name:j4 PIn h a CAR c•S Phone Number:
Plumbing Company: Sieliii014 1%IM1'/if9 Office Phone: ?t fWo7 S93Od/ Fax
Co. Address: 5 S7 I��CKSo/t RdCity: C,CCSMVI)('e State: (zZ_Zip: 322.07
License Holder: r'y 8 IaGk State Certification/Registration # CPC HZ88'o4
Notarized Signature of License Holder7‘ -
The foregoi strument w acknowledged b re me this , day of- d cid , 202-"In the State of Florida,
County of vVsa—
. .4
Signature of Notary Publics 9—_
•'! :'<arvkTONIGINDLESPERGER
1 ,: !•‘ MY COMMISSION ilGG3531T8 Personally Known OR [ ] Produced Identification
:-. :..;C:;;;$ EXPIRES:October 6,2023
''FF A?"' Bonded'Nu Notary Public unden+rners Type of Identification:
Updated 10/17/18