Permit Plbg 1978 Brista De Mar 2011 CITY OF ATLANTIC BEACH
IV k
y 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5826
e ns
Application Number . . . . . 11- 00001880 Date 4/06/11
Property Address 1978 BRISTA DE MAR CIR
Application type description PLUMBING ONLY
Property Zoning TO BE UPDATED
Application valuation . . . 0
Application desc
15 fixtures
Owner Contractor
PURCELL KENNETH & STANTON JILL NELSON PLUMBING CO. INC.
1978 BRISTA DE MAR CIR 11624 DAVIS CREEK ROAD E
ATLANTIC BEACH FL 32233 JACKSONVILLE FL 32256
(904) 262 -4884
Permit PLUMBING PERMIT
Additional desc .
Permit Fee . . . 160.00 Plan Check Fee . . .00
Issue Date . . . Valuation . . . . 0
Expiration Date . 10/03/11
Other Fees STATE PLBG DCA SURCHARGE 2.40
STATE PLBG DBPR SURCHARGE 2.40
Fee summary Charged Paid Credited Due
Permit Fee Total 160.00 160.00 .00 .00
Plan Check Total .00 .00 .00 .00
Other Fee Total 4.80 4.80 .00 .00
Grand Total 164.80 164.80 .00 .00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
FROM : FAX NO. :9048238736 Apr. 06 2011 07:36AM P1
c . . PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
(7\v)19 800 Seminole Rd Atlantic Beach, FL 32233
y Ph (904) 247 -5826 Fax (904) 247 -5845
JOB ADDRESS: 19 1I F e i ... /k2 C ..v PERmIT # // ' /611 °
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FIXTURE WY 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 -
RE -PIPE; .
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY /,_:,
Bathtub 1 Septic Tank & Pit
Clothes Washer — 1 Shower .. t 7
Dishwasher Pan
Drinking Fountain ""�- Slop Sink —
Floor Drain Three Compantnont Sink
Floor Sink Toilet
Hose Bibs = Urinal
Kitchen Sink ___I ___ . Vacuum Breakers . _.
Laundry Tray Water Connected Appliances
Lavatory 3 Water Heater _..4 _ ^
Other Fixtures Water Treating System _ _ IW
MISCELLANEOUS:
El Sewer Replacement El Back Flow Preventer 0 Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
a Lawn Sprinkler System- Number. of Heads ❑ Well **
** S AWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection. **
U Other
Permit becomes void if work does npt commence within a six month period or work is suspended or abandoned fo six months. I hereby certify that thaw read •
this application and ICnow 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.
Property Owners Name al l l ,. -rr, it FD f�` ,�. ' ' PL c e_ I I . Phone Number 53 9 - S I S qs
Plumbing Company , Eon ? tk m • Office Phone , • G , Fax q 23- c m_e
Co. Address: „ (v. 1- 1 • 1,S _ r ' 1 11 � ., C' .y .6 . . i ,,I ,1", Zip 12 2., E
License Holder (Print): • C 6 Iv F/DJ ' , /erti:i. R 1- n # C E C � D 3 " yl i C�
Notarized Signature of License Holder f r I I
P. SASS
l.ls� Sworn and subscrib • before me . day of / 20 1i
C.tIA lomas i� ODMB
EXpIRES tin a/ OTAA Signature oi' Notary Public /� Oa- , i ,- _ ,
WHOM THRU / 41111 N0TARYi , - , -„
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