1464 SEMINOLE RD - PLUMBING 04'‘ ''.14:,:44.:!4 4 \I, CITY OF ATLANTIC BEACH
it ) 800 SEMINOLE ROAD
j .. _,�, :,,R: 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-1993
Job Type: PLUMBING ONLY
Description: 4 FIXTURES AND SEWER
Estimated Value:
Issue Date: 8/24/2015
Expiration Date: 2/20/2016
PROPERTY ADDRESS:
Address: 1464 SEMINOLE RD
RE Number: 171954-0000
PROPERTY OWNER:
Name: SCHAFER JR, MAX EDWIN
Address: 1464 SEMINOLE RD
GENERAL CONTRACTOR INFORMATION:
Name: JERRY NOLAN PLUMBING INC
Address: 3115 HAMPSTED DR QA JERRY JAMES NOLAN
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: $94.00
PI:R\tfr IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION f�� 3
CITY OF ATLANTIC BEACH G -. i
800 Seminole Rd Atlantic Beach,FL 32233 1 /,(L
Ph(904)247-5826 Fax(904)247-5845 1
JOB ADDRESS: �7 6 1 S( 4" (.71 0 ( gel PERMIT l#
NEW OR REPLACEMENT INSTALLATION: Project Value$ Li g04'd)
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 __I__
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
20(
Lavatory _I _ Water Heater
Other Fixtures _ - Water Treating System
RE-PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE QT I'
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
MICELLANEOUS:
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 aut o violate the provisions of any other state or local law regulation construction or the performance of construction.
Property
Owners Name Q E . Phone Number
Plumbing Company 3 7 No (a M
Lit.S J 1 L Office Phone 7lrt-0 0Sl Fax 4 V/`9CV-6
P.D. (� 3 CO C. y/ City c��,kso'✓."t" State FL Zip 3�73f-OLY�
Co. Address: Y
License Holder(Print): 0cnr '7 P.l'.n State Certification/Registration# C:C OS 71F?g
Notarized Signature of License Holder = i i) — =�'
ore me this a d.' I A! 20 �'
� _
�p�°"Y 0% Notary Public State of Florida ��`
Shirley L Graham • ��=
� a c� My Commission FF 086990 T_nature of Notary Pu c ���,�
of N°� Expires 02/14/2018