145 8th St (vault) CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
jV y yr ATLANTIC BEACH, FL 32233
>..\ INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-PLBG-2862
Job Type:
Description:
PLUMBING ONLY
PLUMBING - PARTIAL SEWER REPLACEMENT
Estimated Value:
Issue Date: 12/9/2015
Expiration Date: 6/6/2016
PROPERTY ADDRESS:
Address: 145 8TH ST
RE Number: 170323-0000
PROPERTY OWNER:
Name: WAITS, ROBERT F
Address: 145 8TH ST
GENERAL CONTRACTOR INFORMATION:
Name: DAVID GRAY PLUMBING INC.
Address: 6491 S POWERS AVE QA DAVID FRED GRAY
Phone: - -
FEES:
State PLMG DBPR Surcharge $0.00
State PLMG DCA Surcharge $0.00
Trade Permit Base Fee $0.00
Total Payments: $0.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
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Mar 08 10 12:54p Information SystemsCITY 0 904--247-5845 p.1
• PLUMBING P7 1 M1T APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233 Q p
Ph(904)247-5826 Fax(904)247-5845 15 — P L`J6 ` Z Cj 6,
JOB ADDR SS: 145 S-' 5+-. A+lOyj+ic, bead, (L333 PEr
NEW OR REPLACEMENT Y'INSTALLATION: Project Value $
TYPE ors FIXTURE QTY TYPE OF FIXTURE On'
Bathtub Septic Tank&Pit •
Clothes Washer Shower
-Dishwasher Pan
Slop Sink
b
o Three Compartment Sink .
Floor Sink Toilet •
Hose 13ibs Urinal -
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater '
'Other Fbdures Water Treating System
RE-PLPE: •
TYPE OF FThrIZRE QTY TYPE OF FrxruRE Orr
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain _____. Sink
Floor Drain _- -...__ Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal -
Kitchen Sink Vaciun Breaker
Laundry Tray Water Connected AppIiasces
Lavatory Water Heater
Other Fi=res Water Treating System
A. CELLANEOUS:
Sewer Replacement ❑Back Flow Preverxer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plates)
❑ -Lawn Sprinkler System 4:luaiber of Heads ❑ Well *'
** SIRWD Well Completion Form. Completed form to be submitted to the Building Department for feral inspection.**
V
?crmit becomes void if work does net 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 govnning this wor>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 perffoormance of(construction.
...------• ," _101' 11, I qit
Property Owners Name j 0/Th/1� V v al� Phone I'��nber
Plumbing Company David Grey Plumbing, Inc. . . Office Phone 1W-1,----5-S- Fax 7 -��" 'i
Co. 8850 Or.:.,r a t;€lore Court State Zip -12 ?5
Address: 1- ., - ^.nn9,,„ City r
License Holder(Print): State Cert caiionlRegistra*i C � �`L� /
Notarized Signature of License Holder 1rx411•�X n �
'
Sworn and subscribed before me 1� • day of e CP,ryN 20 15
Notary Public State of r•:,,:a
ti,...... e of Notary Public
. Wendy Raft
y� My Commission FF 133678 •
'4"„ow Expires 08/17/2018
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