382 7TH ST WATER SFTNER CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
J _ 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-1059
Job Type: PLUMBING ONLY
Description: water softner
Estimated Value:
Issue Date: 5/5/2015
Expiration Date: 11/1/2015
PROPERTY ADDRESS:
Address: 382 7TH ST
RE Number: 169907-0000
PROPERTY OWNER:
Name: STEVENS ELIZABETH H & JOHN J,
Address: 382 7TH ST
GENERAL CONTRACTOR INFORMATION:
Name: AFFORDABLE WATER/KINDER INC
Address: 3760 KORI RD SPECIALTY WATER (CONS TDS QB)
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.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: ��S'Z. _7ST►2�E7 _ /�TLf�nir� G i�Cl+�l-F PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value $ �' c
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: gallons(Requires 3 sets of plans)
❑ Sewer Replacement F-1BackFlow Preventer ❑ Grease Interceptor (Trap) g
❑ Lawn Sprinkler System-Number of Heads
❑ Well **
** SJRTVD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
Other
ify that I have
s. I hereby cert
ermit becomes void if work does not commence within a Ail mon cions of laws and ord nan or work is suspended sgoverning this abandoned or woo k wr six ill behco plied with het er pecifiedd
this application and know the same to be true and correct. p
or not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the performance Z construction. I
Property Owners Name t�F-773?'°� � °w s�� Phone Number _
vVA'>"£ Office Phone 2-t-,L��--0 I��1 Fax O2�o V l°2 9 z
Plumbing Company. A FFo R D/a [� t.� �, zip 3225
O R i IROA City �cKSono �e State L
Co. Address: 3 r76 0 K �� I
License Holder(Print): h'�A R
State Certification/Registration#
Notarized Signature of License Holder ��12��% C ! I S
111c� 20
Notary Public stele of Florida Sworn and subscribed bef e this `� day of y
Dorothy M Devore
My commission EE 854381 Signature of Notary P lit
or Expires 02!0812017