726 CAVALLA RD PLUMBING CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
]OB INFORMATION:
Job ID: 15-PLBG-956
Job Type: PLUMBING ONLY
Description: 10 fixtures repipe
Estimated Value:
Issue Date: 4/24/2015
Expiration Date: 10/21/2015
PROPERTY ADDRESS:
Address: 726 CAVALLA RD
RE Number: 171365-0190
PROPERTY OWNER:
Name: ODONNELL, BRIAN M
Address: 726 CAVALLA
GENERAL CONTRACTOR INFORMATION:
Name: TERRY VEREEN PLUMBING
Address: 2934 POST ST QA TERRY LEE VEREEN
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $70.00
Trade Permit Base Fee $55.00
Total Payments: $129.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC REACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(9/044)2447/-5826 Fax(904)247-5845
JOB AD DRESS: oC 10 C AlO i'7 PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Values 1 X W
TYPE oFFUTURE QTY TYPE oFFIXTuRE 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:
TYPEoFFDrTORE QTY TYPE oFFLYwRE QTY
Bathtub I Septic Tank&Pit -
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain _0 Three Compartment Sink
Floor Sink o Toilet
Hose Bibs Urinal
Kitchen Sink IO Vacuum Breakers
Laundry Tray o ` Water Connected Appliances
Lavatory y' Water Heater
Other Fnctures _ Water Treating System
MISCELLANEOUS:
:] Sewer Replacement ❑Back Flow Preventer ❑ Orem Interceptor(Trap) gallons(Requires 3 sets of plana)
:1 Lawn Sprinkler System-Number of Heads ❑ Well '•
k*&fRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
D Other
?emtit 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
his application and know the same to be We and correct All provisions of laws and ordinances governing this work will be complied with whether specified
x not. The permit does not give authority to violate the provisions of my other some or local law regulation wristmction or the pp�erformance of construction.
Property Owners Name N ILS NGU Y en Phone Numbery t'a 162-C g�q
Plumbing Company QQ/PteCAA C6 OfficePhonecld4 -38Y-601 Fax4aV 9MQg2Z
Co.Address: 06 lZtSGelle 8+~ z City State,tZip ?zay
License Holder(Print): - to Certification/Registration# CF<d 25S47
Votarlud Signature of L icense Holder
i`. , is Sworn and subscri before me this 23,✓ day of RPIu L 2015
rr 11'/COWrS]WtIEEEfia2n
w �. II E ai I, Signature of Notary Public --T r Z,