44 Jackson 2015 sewer replavemnt CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
;J r 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: 15-PLBG-608
Job Type: PLUMBING ONLY
Description: SEWER LINE REPLACEMENT
Estimated Value:
Issue Date: 3/17/2015
Expiration Date: 9/13/2015
PROPERTY ADDRESS:
Address: 44 JACKSON RD
RE Number: 172073-0000
PROPERTY OWNER:
Name: HARRIS,DARRYL L & LACRESHIA,
Address: 1159 DORWINION DR
GENERAL CONTRACTOR INFORMATION:
Name: AFFORDABLE PLUMBING COMPANY OF
Address: 4545 ST AUGUSTINE RD QA ROBERT SCOTT CHICOSKI
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $7.00
Trade Permit Base Fee $55.00
Total Payments: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Mar 171502:00p Affordable Plumbing Co 9044486055 p•1
BUY G PERMIT APPLICATION I,
CITY OF ATLANTIC BEACH w
800 Seminole Road, Atlantic Beach, FL 32233
Office(904)247-5826 Fax(904)247-5845
l CLQ c� IZ Permit Number:
fob Address:_ o
Parcel# 1 �' - J
Legal Descriptiont. t
Valuation of Work
Oa Proposed Work heatedJcooled`— non-heated/cooled„�
New Addition Alteration epai Move Demolition pool/spa windowldoor
Class of Work(circle one):
Use of existing/proposed structures)(circle one):. Commercial esid ial
if an existing structure,is a fire sprinider system installed? (Circle one): es No N !A
Florida Product Approval #
For multiple products use pr net approva orrn
Describe in detail the type of work to be performed: 1•��
Property Owner Information:
t,, t-�_/.�r� :S Address: � L I �GL G @�S o
T "�e:City n ;Un r � State�'!�Zip Phone ` ic)3 Z
E-Mail or Fax 9(Optional)
Contractor Information: ; ,c �,-
��, f Qualifying Agent: Zi
Company Name: 3 City it �;� 1 4 State_ - � P
Address: - Fax os
Office Phone;rte � �oc� Job Site/Contact Number'50
State Certification/Registration
r->
Architect Name&Phone#
Engineer's Name & Phone 4
Fee Simple Title HolderName and Address
Bonding Company Name and Address
Mortgage Lender Name and Address
that no work or installation has commenced prior to the
4pplicatianull
n is hereby made to obtain a permit to do the work and installations as indicated.regulating
pe months at any tame after
in
S 'its, Wells, Pools,Furnaces, 9,00's,Heaters,
issuance
fa permit and that all work it be per armed t or t the ruct ro oak lssuspe ed o�abandoned a us�tod f six(6)mo permit becomes
and void:{work is not commenced with cel Work, Plum6ertg,S4
ns,
and Air Conditiwork is coinmenced oners,and understand that separate permits must be secured for Eledri
WARNING TO OWNER: YOUR FAILURE TOGRTECORD UR I TICS OF
, LMENTS
COMMENCEMENT MAY RESULT IN YOUR CONSULT WITH
TO YOUR PROPERTY. IF YOU INTE ND�TE����C��I�I�3G YOUR NOTICE OF
YOUR LENDER OR AN ATTORNEY COMMENCEMENT.
Is and to violate or cancel the
rti �that 1 have read and examined this a le
o nknow
o Theegranting of a Permit ddoescno oPnrerume+to o th u3'ordinances governing i i
!here ce fi ormance a construe /
type of work hilt be complied with whether speer ted he �
provisions of any other federal,state,or loca!law regulating construction or the performance f
�Q �itr'Gt< �
Signature of Contractor ✓'�'L
Signature of Owner ) �. � �(-1
Print Name . .....___..__._.._.._..-..__.._._..._._..__.-_._........
Print Name _.-.-........_ _ _..
.__................_......._..
Sworn to and subscribed e `o�r,`e me 20
Sworn to and subscribed before me .20 this * Day of
this Day of
NO Notary Public State o1 Fbrida
Notary Public =�/ steven Max Lukenbac i, ,c n t �r, in