70 ROBERT ST PLUMBING CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
r
PLUMBING PERMIT
MUST CALL BY 4PM FOR NE)IT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-PLBG-1327
Job Type: PLUMBING ONLY
Description: 8 fixtures
Estimated Value:
Issue Date: 6/5/2015
Expiration Date: 12/2/2015
PROPERTY ADDRESS:
Address: 70 ROBERT ST
RE Number: 172242-0000
PROPERTY OWNER:
Name: HEEREMA, MICHAEL
Address: 923 N 15TH AVE
GENERAL CONTRACTOR INFORMATION:
Name: JERRY NOLAN PLUMBING INC
Address: 3115 HAMPSTED DR CA JERRY JAMES NOLAN
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $56.00
Trade Permit Base Fee $55.00
Total Payments: $115.00
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
51 Rol,,
/ Ph(904)247-5826 Fax (904)247-5845
JOB ADDRESS: 70 t^OD c r f�s � s�- PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value
TYPE OFF/XTURE 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 oFFixTURE 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 .4 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 **
**SJRWD 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 is 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 we 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 ofany other state or local law regulation construction or the performance ofconstmction.
kProperty Owners Name qf�_(IfnS Phone Number
Plumbing Company�^7 ItWun i4L✓ 60 �rIC Office Phone 794-00-0Fax L4/-£lSYb
Co.Address: City J9 ( k(ondil/i State F6 Zip 3aJ-7C_
License Holder(Print): Dc rLl State Certification/Registration# ZI L 9&'_7 ki,
Notarized Signature ojLicense Bolder ?
Before me this day of 20
Signature of Notary Public