41 CORAL ST - PLUMBING N , CITY OF ATLANTIC BEACH
;� s� 800 SEMINOLE ROAD
J r". 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-1433
Job Type: PLUMBING ONLY
Description: INSTALL 12 FIXTURES
Estimated Value:
Issue Date: 6/18/2015
Expiration Date: 12/15/2015
PROPERTY ADDRESS:
Address: 41 CORAL ST
RE Number: 169593-0000
PROPERTY OWNER:
Name: SHEPARD, HERSCHEL
Address: 41 CORAL ST
GENERAL CONTRACTOR INFORMATION:
Name: ROTO ROOTER SERVICES
Address: 2028 W 21ST ST QA ROBERT VINCENT FARR
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $84.00
Trade Permit Base Fee $55.00
Total Payments: $143.00
PERMIT IS APPROVED ONLY IN ACCORDANCE W IT11 ALL CITY' OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
06-18-15;09: 10AM; ; 1111 # 1/ 1
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
t CDC (904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: 41 CDCQ 5-t-ca t.. PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$/; 0. °
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
RE-PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE Qrr
Bathtub _2— Septic Tank&Pit
Clothes Washer
Dishwasher I Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet ,
Hose Bibs
Kitchen Sink __, Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory - _ Water Heater t
Other Fixtures Water Treating System
MISCELLANEOUS:
O Sewer Replacement O Back Flow Preventer 0 Grease Interceptor (Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads O Well **
SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
O
•
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 I have read
this application end know the same'to be true and correct. All provisions of laws and ordinances governing this wort: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 CY'Sal QA S�n-� (L('d Phone Number % 33S 7
Plumbing Company t *At. - •• :. z_ev c-es .,V • Office Phoneq --? 4-73 Fax SL- 9Q
Co. Address: �� ee - City G_cksexly;kI State F.t-- Zip
License Holder (Print): r/L j/; 1Z1/ , State Certification/Registration#c1 ' yy/,S 9
Notarized Signature of License Holder Am. _
Sworn and subscribed before me this g day of 20 (5-
MICHELLE A.TYNAN
(
. 1 MY COMMISSION a FF216691 Signature of Notary Public /i.', _ ! I AA
'•r EXPIRS:April 2,2019
Y�' BonCeO ThN Notary
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