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420 GARDEN LN - PLUMBING ., Ss1 CITY OF ATLANTIC BEACH li ) 800 SEMINOLE ROAD J Y.. ATLANTIC BEACH, FL 32233 i5VINSPECTION PHONE LINE 247-5814 PLUMBING PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 15-PLBG-1440 Job Type: PLUMBING ONLY Description: INSTALL 2 FIXTURES Estimated Value: Issue Date: 6/18/2015 Expiration Date: 12/15/2015 PROPERTY ADDRESS: Address: 420 GARDEN LN RE Number: 172020-5210 PROPERTY OWNER: Name: MARSHALL, DAVID P Address: 420 GARDEN LN GENERAL CONTRACTOR INFORMATION: Name: INNOVATIVE PLUMBING SERVICES LLC Address: 7061 Rivercrest DR Phone: 904-316-6655 FEES: State PLMG DBPR Surcharge $2.00 State PLMG DCA Surcharge $2.00 Plumbing Fixtures $14.00 Trade Permit Base Fee $55.00 Total Payments: $73.00 PERMIT IS APPROVED ONLY IN ACCORDANCE NYI'111 ALL CITY OF ATLANTIC REACH ORDINANCES AND THE FLORIDA BUILDING CODES. PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph(904)247-5826 Fax (904)247-5845 JOB ADDRESS: 1129 C-c ,(Gn A Vian ttr 6einich PERMIT# NEW OR REPLACEMENT INSTALLATION: Project Value$ TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY Bathtub Septic Tank&Pit Clothes Washer Shower 1 Dishwasher Shower Pan 0,' 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 OF FIXTURE 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 ** **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 six month period or work is suspended or abandoned for six months.I 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 Phone Number Plumbing Company 1.-ryymilwe 'plvvnL & cj 5eirmet5 La Office Phone 404-16-GO< Fax Co. Address: 4061 Lvocn,T 1)2. jr.,Kc R.- lila. s City 7a-K Statek• Zip 32226 License Holder (Print): (1') cm L I,ei.,� ■ State Certification/Registration#(.FC 1L12Xpcj'3 Notarized Signature of License Holder�" FUSCO I N - -70--134-1 I B -0 ,gi'�" JENNIFER WALKER i%efore m 1't ca of_�v 20 1 S !: MY COMMISSION E Ff 011480 ', I f '; :w o�.= EXPIRES:April 24,2017 signature of Notary Publi�� / i/�/ '•44414•' Bonded Thru Notary PuNk Underwriters i , I 0