616 TIMBER BRIDGE LN - PLUMBING --' -J F
�" ,st CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
`� 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-1954
Job Type: PLUMBING ONLY
Description: NEW PLUMB 26 FIXTURES
Estimated Value:
Issue Date: 8/18/2015
Expiration Date: 2/1.4/2016
PROPERTY ADDRESS:
Address: 616 TIMBER BRIDGE LN
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: DON HARRIS PLUMBING CO..INC.
Address: PO BOX 14668 QA NELSON D. HARRIS
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $182.00
Trade Permit Base Fee $55.00
Total Payments: $241.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233( LBQJL,��p Ph(904) 247-5826 Fax (904)247-5845 f /�'' J j? 1516
JOB ADDRESS: / 9/Lo IPEERRMIT#j/�
NEW OR REPLACEMENT INSTALLATION: Project Value$ 0, )
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan 2
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 5
Hose Bibs q _ Urinal
Kitchen Sink T Vacuum Breakers
Laundry Tray ___I___ Water Connected Appliances
Lavatory Water Heater 1
Other Fixtures Water Treating System a+k0
RE-PIPE: "
TYPE OF FIXTURE Q7'Y 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 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 e provisio o y other state or local law regulation construction or the performance of construction.
auor
Property Owners Name < 4 I )/ > Phone Number
Plumbing Comp. y L Don Harris Plumbing Co., Inc. Office Ph ax / 23 4S
Co. Address: LOil A'I DUD P)It/J) City Sta , Zi
License Holder(Print): £ I i • ifs: ; State ertification/Registration# Cre.t J 11 q U
Notarized Signature of License Holds?— / II�iKIM BUTLER Sworn and subscribed befor- m: this I day of 20 G�11101/7/Plw 4.i="E .. Commission#FF 030749
„ �_t•; Expires October 25,2017 i
p Bonded TM,Tray fdnhiwarq*9pp3157ptg Signature of Notary Publi _ .. , _ .