65 SHELL ST PLUMBING CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
1 ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
]OB INFORMATION:
]Ob ID: 15-PLBG-1138
Job Type: PLUMBING ONLY
Description: 26 fixtures new service
Estimated Value:
Issue Date: 5/13/2015
_ Expiration Date: 11/9/2015
PROPERTY ADDRESS:
Address: 65 SHELL ST
RE Number: 169581-0000
PROPERTY OWNER:
Name: SAMC REO 2013 01 LLC
Address: 800 W MONROE ST 800 W MONROE ST
GENERAL CONTRACTOR INFORMATION:
Name: TDG PLUMBING
Address: 4426 LOYS DR QA TRAVIS DALE GAINEY
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $182.00
Trade Permit Base Fee $55.00
Total Payments: $241.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
�+ L` Ph(904)247-5826 Fax(904) 247-5845
JOB ADDRESS: �� C\CLL- S'T PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OFFixruRE QTY TYPE oFFIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower 1-4
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs ._ Urinal
Kitchen Sink Vacuum Breakers
Laundry Tmy I Water Connected Appliances 1
Lavatory Water Heater
Other Fixtures Water Treating System 1
RE-PIPE:
TYPE OFFixTuRE 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:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well
**SIRWD Well Completion Farm. Completed form to be submitted to the Building Department for final inspection.**
❑ Other I rt S i $iA ave,2
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 some 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 Phone Number
Plumbing Com1pauq�TTC .,/r���`�S Office Phone��_n"() Fax - 8S�3
Co. Address: LIL1ate L.o�S - City, Al StateFL zip 2 %4
License Holder(Print)_ J: D `;A '^R7 State Certification/Registration#L'FC' 142`�of.2
Notarized Signature oJLicense Holder r�—�-
Before me this day of 20
Signature of Notary Public