358 Royal Palms dr 20134 Plumb CITY OF ATLANTIC BEACH
s) 800 SEMINOLE ROAD
j ATLANTIC BEACH, FL 32233
PLUMBING PERMIT INSPECTION PHONE LINE 247-5814
•"'��`' ALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
30B INFORMA
Job - -
3ob Type: PLUMBING ONLY
Description: 12 fixtures
Estimated Value:
Issue Date: 10/15/2014
Expiration Date: 4/13/2015
PROPERTY ADDRESS:
Address: 358 ROYAL PALMS DR
RE Number: 171712-0000
PROPERTY OWNER:
Name: CHAPMAN, MARK B
Address: 358 ROYAL PALMS DR
GENERAL CONTRACTOR INFORMATION:
Name: FLOW SOLUTIONS INC
Address:
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $84.00
Work W/O Permit Plumbing $84.00
Total Payments: $172.00
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(9,044) 247-5826 Fax (904) 22Q4,7-58455
JOB ADDRESS: 7 /�11� P�i�S D�</���� G�=oeA& V233 PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Values
TYPE of FIXTURE QTY TYPE of FIXTURE QTY
Bathtub _ Septic Tank&Pit
Clothes Washer Shower ,
Dishwasher L_ 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
** 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 violates the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name Phone Number 70Y 90'Y-3_777
Plumbing Company -1C \�\,,—I Office Phone
Co. Address: �� 5 `�P�y�_�'O�` ,1 S-0 City `-�� Stated Zip
License Holder(Print): �- �= �' �Z 1 \` IN State Certification/Registration# ty�1 4 c7
Notarized Signature of License Holder p ,,/,
Sworn and subscribed befor a thi ay of ��/�- 20�(
�
Signature of Notary Public �' I