872 AMBERJACK LN - PLUMBING CITY OF ATLANTIC BEACH
4-4 800 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-2140
Job Type: PLUMBING ONLY
Description: 12 fixtures
Estimated Value:
Issue Date: 9/9/2015
Expiration Date: 3/7/2.01.6
PROPERTY ADDRESS:
Address: 872 AMBERJACK LN
RE Number: 171146-0000
PROPERTY OWNER:
Name: MCKENZIE, JEROME & CHARLENE, *
Address: 509 CAMELIA ST
GENERAL CONTRACTOR INFORMATION:
Name: PLUMBING BY JOSH
Address: 5677 FLORAL AVE QA THOMAS RALPH PORTER
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $84.00
Trade Permit Base Fee $55.00
Total Payments: $143.00
PERNIIT IS APPROVED ONLY IN A('(:ORDAN(:I. IVII II ALI. CITY OF ATI,ANTI(' BI:ACII ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH L,15&800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904)247-5845 L
JOB ADDRESS: 5707\ 4frisct N* -i' £ /J PERMIT#
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NEW OR REPLACEMENT INSTALLATION: Project Value$ 2 4,t. 7O
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 )
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 -2---Lavatory —A— 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 then�provisi ns of any other state or local law regulation construction or the performance of construction.
Property Owners Name �17 4)/I epics Phone Number P37-S20-6
Plumbing Company b1%.-`,9 .67 • 4 XN/C- Office Phone 7 3 74DOU Fax
Co. Address: 5677 ,F1/4 ) 4X City W State f-L Zip 3 1)
(P ) 1 / 4S t7 ,. la '_
License Holder rint : State Certification/Registration#
Notarized Signature of License Holder A .
Am
�vpYO� : ...,a me this / day 4 1_`I; 20 l
Notary Public State of Florida
•
� � Shirley l Graham oSig ■ture of Notary Public / ��
of A L PC s 02/14/2018 06699