1469 BEGONIA ST - PLUMBING PERMIT rl - 's, CITY OF ATLANTIC BEACH
r
.R -••; _ s� 800 SEMINOLE ROAD
- - X 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-1960
Job Type: PLUMBING ONLY
Description: PLUMBING - REPIPE
Estimated Value:
Issue Date: 8/19/2015
Expiration Date: 2/15/2016
PROPERTY ADDRESS:
Address: 1469 BEGONIA ST
RE Number: 171081-3000
PROPERTY OWNER:
Name: IMOTAN, DGARDO A & VIVIAN. *
Address: 1469 BEGONIA 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 $35.00
Trade Permit Base Fee $55.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Mar 08 10 12:54p Information SystemsCfiY 0 904-247-5845 p.1
PLUMBING PEST APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845 ( 5 - R.36 -19(0 O
JOB ADDRESS: 1`t/ 1 ?...)E(i oil( PERMIT#
NEW OR REPLACE' NT INSTALLATION: Project Value $
TYPE of F QTY TYPE OF FTXrUIRE QTY
Bathtub Septic Tank&Pit •
Clothes'Washer Shower
=Differ 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 Fares Water Treating System
--PIPE: • .
TYPE OF F[XTrE QTY TYPE OF FEE QTY
Bathtub I Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Driniin8 Fountain ` Slop Sink _
Floor Dram — }7 Three Compartment Sink
Floor Sink Toilet 1
Hose Bibs Urinal -
Kitchen Sink 1 Vacuum Breaker
Laundry.
aura Try Water Connected Appliances
Lavatory •. I Water Heater ____I
Other Factures • Wafer Treating System
MISCELLANEOUS:
O Sewer Replacement ❑Back Flow Presenter ❑ Grease Interceptor(Trap)_ gallons(Requires 3 sets of pis)
❑ Lawn Spznkler System Number ofHeads ❑ Well **
** SJRWD Wd!Completion Form. Completed form to be submitted to the Build-ins Department for final inspection.**
fff Other. .1 C, (J aff,raAlt ecl .Jl j >:uks.,.
Permit becomes void if work does not commence within a sax month period or work is suspended or abandoned for six months.I hereby certify that I have rem
this application and know the same to be nue and correct. All provisions of laws and ordinances governing this work will be complied with whether spe ed
or not. The permit does not give 'oriitty to vita.late provisions of any other state or local law regulation construction or the perf••••-• e of constructon.
Property Owners Name V I Y 1 413 4l • Phone number `F'`'T 6O(Ac•
Plumbing Company David Gray Plumbing, Inc. Office Phone 72--5--4) Fax"7 7.-
8850{;orporate• Square Court
Co. Address: __ .�,n City State Zip
�7 ..,..-s.,:
•License Holder(Print): [J;�s�Js"�J Y' .�`1 tate Certi oationlRegistrafi T� # e,ve- r�?2�
Notarized Signature of License Haider % •�
Sworn and subscribed before me thi, 1°141'‘ day of A �� li 20 I
Signature of Notary Public iA .. ..%
�4 4 Notary Public State of,7: Aida i
Wendy Rayle
1� My Commission FF 133678
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