303 ATLANTIC BLVD - WATER HEATERS , , f CITY OF ATLANTIC BEACH
r s) 800 SEMINOLE ROAD
j 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-1632
Job Type: PLUMBING ONLY
Description: 2 WATER HEATERS
Estimated Value:
Issue Date: 7/8/2015
Expiration Date: 1/4/2016
PROPERTY ADDRESS:
Address: 303 ATLANTIC BLVD
RE Number: 169729-0000
PROPERTY OWNER:
Name: JUNK, SHIRLEY
Address: 915 N 13TH ST
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 $14.00
Trade Permit Base Fee $55.00
Total Payments: $73.00
PER\lll IS APPROVED ONLY IN ACCORDANCE NITII ALI, CITY OF .VII.AN'tIC BEACII ORDINANCES AND THE FLORIDA
BUILDING CODES.
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Mar 08 10 12:54p Information SystemsCITY 0 904-247-5845 p.1
PLUMBING PEANUT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845
JOB ADDRESS; 3o3 1 \`' \CL11/"\4C., bid , PEA11 rr
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FVCIMBE QTY TYPE OF FWURE Qrr
Bathtub Septic Tank&Pit •
Clothes Washer Shower
=Disl'rwasher mower Pan
Slop ink
Drinking o gm� • Three Compartment Sink .
Floor Sink Toilet •
Hose Bibs Urinal •
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater ____Q
-Other'Frames Water Treating System
RE-PIPE:
TYPE OF FixTVEE QTY TYPE OF Fixr RE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
n Slop ink
Floor Drain Fountain =- -.-- Three Compartment Sires
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breaker
Laundry.Tray Water Connected Appliances
Lavatory . Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requfres 3 sets of pates)
❑ Lawn Spunkier System=I*7uniber ofHeads ❑ Well **
* SJRWD Well Completion Forte. Completed forn.to be submitted to the Buiidino Department for final inspection.**
❑ other. . Alb . At.. 4NP. to . A At ." r
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for sx months I hereby certify that I have read .
this application and know the same to be t tie and correct. All provisions of laws and ordinances governing this worm will be complied with whether spccit ed
or not The permit does not give authority ta oiate the provisions of any other state or local law regulation con_stniction or the performance of constnicdon.
Property Owners Name A l S I ZZG • Phone Number -/ i 000,4-
Plumbing Company David Graff" Plumbing, Inc. Office Phone 77y-.al) Fax /?T-5-9ar
8350 Corporate Square Court
Co. Address: 1......; ,..._.._ _ m~+3 c City State Zip
License Holder(Print): 1...,spJ. 6 ;.Y- State CertifcationfRegistra?ior# C F(.3 O--` .'gG
Notarized Signature of License Holder (T URAQ w ' Q
Sworn and subscribed before..e this D day of . ) l d ill 20 IS
ignature of Notary Public La0'l.D'X7
cyjjoir
w Notary Public State of Florida v
My Wendy Commission Rulo
My Commission FF 133678
Expires 08/17/2018 •
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