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1164 LINKSIDE DR - PLUMBING r�' /� '` �S, CITY OF ATLANTIC BEACH ,.. ""°" f 800 SEMINOLE ROAD ),IF ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 '-J,i19f' PLUMBING PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 15-PLBG-1449 Job Type: PLUMBING ONLY Description: REPIPE 13 FIXTURES Estimated Value: Issue Date: 6/19/2015 Expiration Date: 12/16/2015 PROPERTY ADDRESS: Address: 1164 LINKSIDE DR RE Number: 172374-5030 PROPERTY OWNER: Name: ALLEN, GLADYS J Address: 1164 LINKSIDE DR GENERAL CONTRACTOR INFORMATION: Name: DAVID GRAY PLUMBING INC. Address: 6491 S POWERS AVE QA DAVID FRED GRAY Phone: - - FEES: State PLMG DBPR Surcharge $2.00 State PLMG DCA Surcharge $2.00 Plumbing Fixtures $91.00 Trade Permit Base Fee $55.00 Total Payments: $150.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. Mar 08 10 12:54p Information SystemsCITY 0 904-247-5845 p.1 PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach FL 32233 Ph(904)247-5826 Fax(904) 247-5845 . . Ii( L id ��AAn>��s. I� �z. � PERmiT NEW ORREPLACEMENT INSTALLATION: Project Value$ TYPE OF FIXTURE ©?Y TYPE OFFITURE QTY Bathtub Septic Tank&Pit • Clothes Washer Shower Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sine . Floor Sink Toilet Hose Bibs Urinal Kitchen Sink Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory Water Heater 'Other Fixtures Water Treating System 1�-P�P�: TYPE OF FixTuRE QTY TYPE OF FEE QTY Bathtub _ Septic Tank&Pit J Clothes Washer _f_ Shower / Dishwasher ---i— Shower Pan Drinking FountaII Stop Sink Floor Drain Three Compartment Sink __z_ Floor Sink Toilet Hose Bibs 2 Urinal Kitchen Sink — I Vacuum Breakers Laundry Tray ____21___ Water Connected Appliances Lavatory - Water Heater I Other Fixtures Water Treating System MISCELLANEOUS: o Sewer Replacement 0 Back Flow Preventer 0 Grease Interceptor(Trap) gallons(_Requires 3 sets of per) ❑ Lawn Sprinkler System Number of-Beads ❑ Well ** ** STRWD Well Completion etiion Form/.. Completed form.to be submitted to the Buildin5 Department for final inspection.** ❑ Other.frt?i PL . N..ea> /s ea s' _._ .. • •,.,,.�_._ - ,t. - - - mt '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 speh od or not_ The permit does not give ority to vic to the provisions of any other state or local law regulation construction or the perf a of construction. Property Owners Name (44,d Phone Ntnnber 14 241 'A 7 Plumbing Company Davit Gray Plumbing, Inc. OM=Phone 1/144- 712-45:43- Fax 773-seal . . 8850 L:orporate Square Court Co. AedTess: City State Zip License Holder(Print): ,A/iV ) 61 _Stat Certifcatian1Registration# ere, 0223; 6' Notarized Sig wtare of License Holder Sworn and subscribed before m • FCC.: day o f 31ti-t"1C 20,15 Signature of Notary Public C. LA37t J 0 Notary Public Stets of Florida LaSheica Wilson 11/4J My Commission FF 180366 0.0F Expires 01/04/2019 - 221K