659 Amberjack Ln 2014 Plumb ,,jrl'`lr
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
JOB INFORMATION:
Job ID: 14-PLBG-25
Job Type: PLUMBING ONLY
Description: SEWER REPLACEMENT
Estimated Value:
Issue Date: 9/17/2014
Expiration Date: 3/16/2015
PROPERTY ADDRESS:
Address: 659 AMBERJACK LN
RE Number: 171189-0000
PROPERTY OWNER:
Name: POPE, MILDRED M
Address: 659 AMBERJACK LN
GENERAL CONTRACTOR INFORMATION:
Name: TERRY VEREEN PLUMBING
Address:
Phone: - -
FEES:
State PLMG DBPR Surcharge
Total Payments: $2.00
State PLMG DCA Surcharge
Total Payments: $2.00
Plumbing Fixtures
Total Payments: $7.00
Trade Permit Base Fee
Total Payments: $55.00
[T�lPayments: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: Ni&ZJQ ,V LW- PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$!,00'60
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
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:
Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
Lawn Sprinkler System-Number of Heads ❑ Well
**SIRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
�i Other
?ermit 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
his 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
)r not. The permit does not give authority to violate the provisionsofany other state or local law regulation construction or the performance of construction.
Property Owners Name :D m e s Phone Number I OL(-663-Y` L(3
Plumbing Company 22 U C0 Office Phone 90g{-_;gfA 9W Fax W-390*22-
_o. Address: 26 Ci kl k'SQh Vtd12 State rL Zip X226 y
License Holder(Print): I ►2r7 e h tate Certification/Registration# CSC G�S517
Of
Votarized Signature of License Holde
�. Swo and subsc ed before me this day of 20
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oWMAId 18,2017 Signature of Notary Public 1-21 �
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