1375 OCEAN BLVD PLUMBING CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
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-1242
Job Type: PLUMBING ONLY
Description: MOVE PIPING INTO THE WALL, 3 FIXTURES
Estimated Value:
Issue Date: 5/27/2015
Expiration Date: 11/23/2015
PROPERTY ADDRESS:
Address: 1375 OCEAN BLVD
RE Number: 171845-0000
PROPERTY OWNER:
Name: MESIANO, MICHAEL AND SANDRA,
Address: 1375 OCEAN BLVD
GENERAL CONTRACTOR INFORMATION:
Name: EMERGENCY REPAIR PLUMBING INC
Address: 1195 WHISPERING PINES RD QA EDSEL FORD GOFF, JR
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: $80.00
PERMIT IS APPROVED ONLY M ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
^1 Ph(904)247-5826 Fax(904)247-58451
JOB ADDRESS: PERMIT
NEW OR PLACEMEN INSTALLATION: Project Value$ 2CQOO
TYPE OFF/XTORE 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:
TYPE oFFIXTORE QTY TYPE of F/XTURE 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:
Cl Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Tmp) 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.**
VOtherly'\(3VQ Qke'N \V-\ �o 'T e WGA\
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 ame and correct All provisions of laws and ordinances governing this work will be complied with whether specified
or not. The pemrit 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 f-' eS> 6m'z�lIC \r) p Phone Number LgatA-(NI 5I
Plumbing Company _ge.�r"lt PVkm\o' ✓t411_6ffice Phone 2)30-QR'_)QD Fax
Co.Address: JJQS \rJ\.\S1P�16re `Plv\ea QA City.. �dM/\S State r-\-- Zip
License Holder(Print): S@\ �__� r. State Certi�fic�a+tion/Regist-lratiion li 0 r,
Notarized Signature of License /.� �V17C 1 6n�71�l p�p lj-IJ
, FEawu�a ore me this�day of 20 �J'
4.6,14" lnvcauassba tFF011M
expinps.crani n,son S' nature of Notary Public
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