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1901 Hickory Ln 2014 plumb �s `S CITY OF ATLANTIC BEACH J 800 SEMINOLE ROAD � s) J u` ATLANTIC BEACH, FL 32233 rr�� INSPECTION PHONE LINE 247-5814 r�JJi19' PLUMBING PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 14-PLBG-494 Job Type: PLUMBING ONLY Description: 3 fixtures Estimated Value: Issue Date: 11/21/2014 Expiration Date: 5/20/2015 PROPERTY ADDRESS: Address: 1901 HICKORY LN RE Number: 172020-1322 PROPERTY OWNER: Name: MORTON, JOAN G Address: 1901 HICKORY LN GENERAL CONTRACTOR INFORMATION: Name: COURTESY PLUMBING INC Address: 1205 LAMANTO AVE WILLIAM TRAVIS GLASS Phone: - - FEES: State PLMG DBPR Surcharge $2.00 State PLMG DCA Surcharge $2.00 Plumbing Fixtures $21.00 Trade Permit Base Fee $55.00 Total Payments: $80.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CPTY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 P /(904) 247-5826 Fax (904) 247-5845 JOB ADDRESS: Q PERMIT# NEW OR REPLACEMENT INSTALLATION: Project Value$ TYPE of FIXTURE QTY TYPE of FIXTDRE 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 ** **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 provisions of any other state or local law regulation construction or the performance of construction. Property Owners Name Phone Number Plumbing Company !�r e5' / Office Phone 201 036Z-Fax Co. Address: Cityp�7 State�Zip License Holder(Print): W S s State Certification/Registration# Notarized Signature of License Holder I re me this Z / day of � 10U/J 20 L jo ��Y'`s� Notary Public State of Florida Shirley L Graham Sj Mature of Notary Public n cY My Commission FF 086990 �os►�oa Expires 02/14/2018 -72, - 137 - �