595 COASTAL OAK LN PLUMB 2015 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
'J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
L J131>r
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-PLBG-249
Job Type: PLUMBING ONLY
Description: 19 fixtures
Estimated Value:
Issue Date: 2/3/2015
Expiration Date: 8/2/2015
PROPERTY ADDRESS:
Address: 595 COASTAL OAK LN
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: NELSON PLUMBING CO. INC.
Address: 11624 -1 DAVE DAVIS CREEK RD QA SCOTT GARY
NELSON
Phone• - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $133.00
Trade Permit Base Fee $55.00
Total Payments: $192.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph/(90,4,) 247-5826 Fax (904) 247-5845
JOB ADDRESrS:. ,5�5 C, C( Oa-V Lai-7-p__ PERmT# S 51S
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE of FIXTURE QTY TYPE of FIXTURE QTY
Bathtub I Septic Tank&Pit
Clothes Washer �_ Shower 1;Z
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 t Water Heater
Other Fixtures Water Treating System
RE-PIPE:
TYPE of FIXT uR.E QTY TYPE of FiYTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shbwer 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.*'
❑ 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 rea
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 a r c U-�t de ffnm P .s Phone Number
Plumbing Company �1�� VM b t C-- O ce Phone a�a I&W Fax FSJ9- 73CP
,
Co. Address: I t b-2 —I ))Gv►S �t Statr�Zip ?,Id
License Holder(Print : S 117 &ite'
Certification/Registration# G�' D a 6375
S" afitA��•�tkrps5 older
tary Public tate o on a /�
•;�; My Comm.Expires Nov 16,
201
p� day Q 2011
'o= Commission # EE 137475 Swom and sub ribed efore me s
Bonded Through National Notary Assn.
Signature of Notary Public