65 19TH ST - PLUMBING Jt4
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S\\ CITY OF ATLANTIC BEACH
- ; 800 SEMINOLE ROAD
J *x ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
. 5814
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PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-PLBG-1573
Job Type: PLUMBING ONLY
Description: 3 FIXTURES
Estimated Value:
Issue Date: 6/30/2015
Expiration Date: 12/27/2015
l
PROPERTY ADDRESS:
Address: 65 19TH ST
RE Number: 169723-1040
PROPERTY OWNER:
Name: SWEENEY,DAVID & PATRICIA, *
Address: 65 19TH ST
GENERAL CONTRACTOR INFORMATION:
Name: TERRY VEREEN PLUMBING
Address: 2934 POST ST QA TERRY LEE VEREEN
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $21.00
Trade Permit Base Fee $55.00
Total Payments: $80.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
// Ph (904) 247-5826 Fax (904)247-5845
JOB ADDRESS: 6o 5 19 S\ NO Q 1
PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$ SjO(.0 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 v PriltA-1 -1F1-0414w Water Treating System
RE-PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE
Bathtub QTY
Clothes Washer Septic Tank&Pit
Dishwasher Shower
Drinking Fountain Shower Pan
Slop Sink
Floor Drain
Floor Sink Three Compartment Sink
Hose Bibs Toilet
Kitchen Sink Urinal
Laundry Tray Vacuum Breakers
Lavatory Water Connected Appliances
Other Fixtures Water Heater
Water Treating System
MISCELLANEOUS:
i Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
Lawn Sprinkler System-Number of Heads ❑ Well **
k*SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
Other
?ermit 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
his 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
mr 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 S lAW .l•d
Y Phone Number
Plumbing Company V2 / 0\2.9_0_,0 { C- Office Phone`lx) 3SSLi-5061
Fax(to4-3n-842Z
:o. Address: a(0et6 i2o ssele '.\— City e State ( L Zip 32-204/
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License Holder(Print I P Q,C? State Certification/Registration# Ct=CO.25 Sl7
Votarized Signature of License Holde I , I It 1 1
! -��� metro a Sworn . d subsc ',ed before me this 261 day of )�� 20 I S-
to oiuE. r.si _ Y S F
X.," "�'a�01 Signature of Notary Public l�n�,
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