343 PLAZA PLRS23-0056 Plumbing Permit Application **ALL INFORMATION
�S% lr�,, HIGHLIGHTED IN
t,, City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 �L�Sz J`00E-_,p
'�u;t'r Phone: (904)2247-5826) Email: Building-Dept@coab.us PERMIT2#: iI E-51:� zx"A�
JOB ADDRESS: 3*' /2)9'4. PROJECT VALUE$ /
❑NEW OR REPLACEMENT INSTALLATION and/or 111 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 I
Other Fixtures Water Treating System
CI MISCELLANEOUS
\:.Sewer Replacement '
Back Flow Preventer
Lawn Sprinkler System (number of sprinkler eads)
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: 40, AdPrt- Phone Number: � _ Zal
Plumbing Company: 4 'P ,8 (U Me Office Phone: e.,/91 Fax
Co. Address: .4/ ' 5
/4 ) /1- City: 414 &A State:ft Zip:3424
License Holder: ,,qh,/l State Certification/Registration # G--f 3719`
Notarized Signature of License Holder4— -
The foregoitrument wallsacknowledg before me this 7 day • too , , ;25-,the State of Florida,
County of W L7 [O..
I
Signature of Notary Public .
a TONI GINDLESPERGER
• ersonally Known OR [ ] Produced Identification 4
;,:::..k...:„-=, MY COMMISSION#GG 353178
EXPIRES:October 6,2023
L f_oType of Identification:
f'''''' Bonded T�,ru Notary Public Underwriters
______ Updated 10/17/18