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857 AMBERJACK LN PLUMBING CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 s� INSPECTION PHONE LINE 247-5814 PLUMBING PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 IOS INFORMATION: Job ID: 15-PLBG-1161 Job Type: PLUMBING ONLY Description: SEWER REPLACEMENT Estimated Value: Issue Date: 5/15/2015 Expiration Date: 11/11/2015 PROPERTY ADDRESS: Address: 857 AMBERJACK LN RE Number: 171181-0000 PROPERTY OWNER: Name: KSN INVESTMENT CORP, ' Address: 9191 SKINNER PKWY APT 501 GENERAL CONTRACTOR INFORMATION: Name: BECKWITH PLUMBING INC Address: 2653 PARRISH CEMETERY RD MARK ANTHINY BECKWITH 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 rr^� Ph(904)24�7-582� L 6r' Fax (904)247-5845 ( �v al JOB ADDRESS: D I &i '/J PERMIT# NEW OR REPLACEMENT INSTALLATION: Project Values TYPE oFFIXTURE QTY TYPEoFFIXTURE 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 oFFIXTURE QTY TYPE of FIXTORE 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: 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 read 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 e , \ 7.2 C� Phone Number 2W- 7M PlumbingCompany�Yl��lf-ir4.hP Il. �YY1. ,^01ttir' OfficePhone{sC13- 01S� Fax 6�/3-0S'D�/ Co. Address: a.6S3 �o tNVS , L� AeAl (2-6 cityJ ci-�- State/= zip 3zz2 License Holder(Print): ffipw� Certification/Registra�tion#LFL OSfSDZ6 Notarized Signature of License Holder - rt.L32-�-.isktM I-Sq -oG 3- d t +^ ,, IEaxlFra wwua Beforemethisle`-�+ �a of Ma 20 qqjjpp MY COMMISSIIXVY FFc11480 ExPIflES:Fpal24,W17 Signature of Notary Public( � ,•;,,,,,,�v��-"_-.TY<<<«<.'''"' comae muwnrvwa wamsa