1946 BEACHSIDE CT PLRS24-0007 PARS Z4 00C)
Plumbing Permit Application **ALL INFORMATION
/ HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
-7_6' Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT##: 02-55
JOB/ADDRESS: ittp Y\ *I'S PROJECT VALUE $ ',... F901)
NEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer Shower
Dishwasher I Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet _t—
Hose Bibs Urinal
Kitchen Sink 7--- Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
El MISCELLANEOUS
❑ Sewer Replacement
❑ Back Flow Preventer
❑ Lawn Sprinkler System (number of sprinkler heads)
❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
❑ Well **SIRWD 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.
' CDOwner Name: ✓ — . r Phone Number:
Plumbing Company. i'\ WI t ii a Office Phone: jY O Fax .gf
Co. Address: \'1 ", 1 CI City:9 Wel StaterZip: 9 ha.
License Holder: \t\1 ? /State Certification/Registration # -
'I 6 /
Notarized Signature of License Holder
\I\I\
The foregoi! instrument was acknowledged before me this ( t�ay of--Sek-r\ , 20Z in the State of Florida,
County of LT LJv;.A t_
) C
o .��.. . TONI GINDLESPERGER
§oii ': MEXPIRE COMMISSION#HH407122 -reKnown OR [ ] Produced Identification
�•:EOF Fro?:• EXPIRES:October 6,2027
Type of Identification:
Updated 10/17/18