901 OCEAN BLVD #16 - PLUMBING f)
(;(0,,t1/J:r
', sA CITY OF ATLANTIC BEACH
0 800 SEMINOLE ROAD
73v x
ATLANTIC BEACH, FL 32233
'..tn 0INSPECTION PHONE LINE 247-5814
PLUMBING RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: PLRS17-0097
Description: CLOTHES WASHER
Estimated Value: 0
Issue Date: 9/5/2017
Expiration Date: 3/4/2018
PROPERTY ADDRESS:
Address: 901 OCEAN BLVD 16
RE Number: 170237 0282
PROPERTY OWNER:
Name: SUTHERLAND DAVID
Address: 901 OCEAN BLVD # 16
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: KELLOW'S RAPID RESPON PLUMBING
Address: 815 PLAZA
ATLANTIC BEACH, FL 32233
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
•
PLUMBING PERMIT APPLICATION •
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax(904)247-5845 p L R S 17- 0 09
JOB ADDRESS: 90/ 0' 6"---44/ L9L 4 t4,-17- /b PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer ____L__ 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
Other Fixtures Water Treating System
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
Other Fixtures Water Treating System
MISCELLANEOUS:
o Sewer Replacement 0 Back Flow Preventer ❑ Grease Interceptor (Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ 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 visions of any other state or(local law regulation construction or the performance of construction.
Property Owners Name C)CLQ( lQt– (gA_C__ Phone Number
PY
Plumbing Company Kr1000✓S PA-P 0 `c vse- fui a�, Office Phone , w 7-65317 Fax pLi S6 2351--
Co.
352Co.Address: 6.25y ,a06,44 J ,4(it=.. H 't 0- 6 2 9 Cityi—y State r( Zip -3"i 7
License Holder(Print): F&7 //kL(,]. State Certification/Registration# c1 ya6` 7.5---
Notarized Signature of License Holder /i s ;/. /
,:ls'e'••., PATRICIA A.HENRY Before me this } 9 day of 20 \ 'i
;-*..,Commission#FF 083273
V-,-4.5 ExpiresTlw Troy iaq May .;2018 AAU�71kd91. Signature of Notary Public
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