900 PLAZA #86 (2) ili
�s °,'tCITY OF ATLANTIC BEACH
1
� � 800 SEMINOLE ROAD
j a 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: 14-PLBG-639
Job Type: PLUMBING ONLY
Description: UNIT#86, INSTALL 3 FIXTURES
Estimated Value:
Issue Date: 12/17/2014
Expiration Date: 6/15/2015
PROPERTY ADDRESS:
Address: 900 Plaza
RE Number: 171725-0500
PROPERTY OWNER:
Name: SEA OATS ACQUISITIONS, LLC
Address: 645 MAYPORT RD SUITE 5 645 MAYPORT ROAD SUITE 5
GENERAL CONTRACTOR INFORMATION:
Name: FLORIDA EMPIRE PLUMBING INC
Address: 5358 HIDDENS GARDENS DR QA ELVIS K LUKAJ
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: $80.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904)247-5845
Jos ADDRESS: f60- IOMV�% �f�'yn%r t�'�'�. �i G 34z S3 _PERMIT#
1�lel go/ --� ok-
NEW OR REPLACEMENT INSTALLATION: Project Value$
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 C1 Well
**SJRWD Well Completion Form. Completed orm to be submitted to the Building Department for final inspection.**
❑ Other J0
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 la%v regulation construction or the performance
f construction.
Property Owners Named ,�C�J Phone y umber 2 4, 14V
Plumbing Company Office Phone yti r=25�3�Fax 7?J-ZZj
Co. Address: �3 } �f��/� J di City lL'���StateLZip �'�
License Holder(Print): L�/��J �+LL'.�'-� State Certification/Registration 4
Notarized Signature of Lkense Holder
Sworn and subscribed before me this day of 20
Signature of Notary Public