1758 W PARK TER PLBG r � CITY OF ATLANTIC BEACH
it 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
308 INFORMATION:
Job ID: 15-PLBG-2011
Job Type: PLUMBING ONLY
Description: 17 fixtures
Estimated Value:
Issue Date: 8/26/2015
Expiration Date_ : 2/22/2016
PROPERTY ADDRESS:
Address: 1758 W PARK TER
RE Number: 172020-0360
PROPERTY OWNER:
Name: BELL SR TRUST, RICHARD W
Address: 1758 W PARK TER
GENERAL CONTRACTOR INFORMATION:
Name: TERRY VEREEN PLUMBING
Address: 2934 POST ST QA TERRY LEE VEREEN
Phone:
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $119.00
Trade Permit Base Fee $55.00
Total Payments: $178.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax (904) 247-5845
JOB ADDRESS: I 1 �"�— � C'� PERMrr#
NEW OR REPLACEMENT INSTALLATION: Project Value$
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 ( Septic Tank&Pit
Clothes Washer 1 Shower 2
Dishwasher I• Shower Pan 0
Drinking Fountain 0 _ Slop Sink 6
Floor Drain d Three Compartment Sink _Q__
Floor Sink O ToiletHose 3'
Urinal O
Kitchen Bibs
Sink Vacuum Breakers 0
Laundry Tray O Water Connected Appliances 0
Lavatory 3 Water Heater 1
Other Fixtures O \ Water Treating System
MISCELLANEOUS:
�i Sewer Replacement ❑ Back Flow Preventer ❑ G Interceptor(Trap) gallons(Requires 3 sets of plans)
:i Lawn Sprinkler System-Number of Heads �' ` ❑ Well **
*
SJR WD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
:i Other
'ermit 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
:his 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
)r 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 ����5 C��oo� Phone Number 56t-970._226(
Plumbing Company �E~��� �Q��'� p� �ti n� Lo Office Phone gc)0�4-�566) Fax964-32;'g`t22
_o. Address: City Jl-Oyy_cayAp__ State L Zip 3224
6
License Holder(Print)• e State Certification/Registration# CFC OJ?5 17
Votarized Signature of License Holder
Sworn an bscribed before me this day ofVA4u St 20
;_ MYOOMssl fEESM17
9a11FtMApd1#.2D17 Signature of Notary Public
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