1816 ATLANTIC BEACH DR PLUMBING . ySl
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
JOB INFORMATION:
Job ID: 15-PLBG-1332
Job Type: PLUMBING ONLY
Description: NEW SERVICE 25 FIXTURES
Estimated Value:
Issue Date: 6/8!2015
Expiration Date" 12/5/2015
PROPERTY ADDRESS:
Address: 1816 ATLANTIC BEACH DR
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: DARLEYS PLUMBING INC.
Address: 4472 PHILLIPS HWY QA CARL LESLIE DARLEY
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $175.00
Trade Permit Base Fee $55.00
Total Payments: $234.00
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
Ph(904)247-5826 Fax(904)247-5845
JOB ADDRESS: I G AT tA-Yru 34_4m PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value 8
TYPEoFFIXTURE QTY TYPEoFFIXTURE QTY
Bathtub 2 Septic Tank&Pit
Clothes Washer 1 Shower i
Dishwasher I Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs — T`T Urinal
Kitchen Sink 1 Vacuum Breakers
Laundry Tray 1 Water Connected Appliances
Lavatory Water Heater I
Other Fixtures I Water Treating System I
RE-PIPE: (
TYPEOFFtXTURE QTY l � TYPE of FIXTURE QTY
Bathtub V 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 plana)
❑ 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.1 hereby certify that 1 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 ("'W Phone Number
Plumbing Company Nay's IPL", -rz.x. I;J� Office PhoneRo4•-7'L7-)yty Fax 10y -7 0 I'fil
Co. Address: 49 ')L Ot{it.t,Vi f{w. City JAY State 6L Zip 3"'7
License Holder(Print): 1"'ACt . State Certification/Registration# CK Ofd 7a'L
Notarized Signature of License Holder L4 -
Sworn and subscribed befo this lay of 20j�
,gANMENL Signature of Notary Public
e°F roi Notary PuaNEhe 6tus of'amur My Comm Expires Aa9 79,1016
; dd.` Commission#EE 679576
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