1949 SEMINOLE RD - PLUMBING rj" , . ';) CITY OF ATLANTIC BEACH
. - - _ 800 SEMINOLE ROAD
`+J ATLANTIC BEACH,FL 32233
\ jy: INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
7OB INFORMATION:
Job ID: 15-PLBG-1602
Job Type: PLUMBING ONLY
Description: 10 fixtures
Estimated Value:
Issue Date: 7/6/2015
Expiration Date: 1/2/2016
PROPERTY ADDRESS:
Address: 1949 SEMINOLE RD
RE Number: 169542-0516
PROPERTY OWNER:
Name: MAZUR. KAUNATH TERESA
Address: 1949 SEMINOLE RD
GENERAL CONTRACTOR INFORMATION:
Name: BILL FENWICK PLUMBING
Address: 11623 E COLUMBIA PARK DR QA WILLIAM K. FENWICK. JR
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $70.00
Trade Permit Base Fee $55.00
Total Payments: $129.00
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: V 9 -e\ ‘rpA e ( PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value
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 QTY
Bathtub k Septic Tank& Pit
Clothes Washer l Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 2
Hose Bibs Urinal 1 j�
Kitchen Sink Vacuum Breakers 11 �J
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement u Back Flow Preventer CI Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads _i 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 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 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'-Ce s(O\ M Qt-2.vY Phone Number 904 -1 y 7--13 95
PIumbing Company b.11 -cer1 t,J\C L VILNY\bV\41 Office Phone -7 Z`l- .1 C-2--2._ Fax `12' — ?(o c
Co. Address:\l U 2S C O\v�bSq -PCt L O r. l(, City io ck So \A Ilastate L Zip 2-)2 2'
License Holder(Print): )t I I- etn \C-� State Certification/Registration# C�Cb`�1d03q
Notarized Signature of License Holder LQJ ,e-A,-(-4 CA-
L 20 S�
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Notary Public sate of Florida Sworn and subs ed before me this4 tO Ji iay of - ,` l
Susan T Slocum Si nature of Notary Public ARY'(7.1V-- -•^---
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My Commaaion FF 1560?? g y ,
‘...../
Expires 03/06/2018