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357 MAIN ST - PLUMBING . :J� y �s f CITY OF ATLANTIC BEA ( s) 800 SEMINOLE R i' 1 +J _r ATLANTIC BEACH,FL 3 INSPECTION PHONE LINE 247- . ..~t J3319r PLUMBING PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 30B INFORMATION: Job ID: 15-PLBG-2169 Job Type: PLUMBING ONLY • Description: NEW SERVICE (UNDERSLAB ONLY) NO FIXTURES Estimated Value: Issue Date: 9/14/2015 Expiration Date: _ 3/12/2016 PROPERTY ADDRESS: Address: 357 MAIN ST RE Number: None GENERAL CONTRACTOR INFORMATION: Name: PLUMB-PAL, INC. Address: 1728 SABLE PALM LN QA MICHAEL JOSEPH CARPENTER Phone: - - FEES: State PLMG DBPR Surcharge $2 00 State PLMG DCA Surcharge $2.00 Trade Permit Base Fee $55.00 Total Payments: $59.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLO BUILDING CODES. 1. PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph(904)247-5826 Fax (904)247-5845 JOB ADDRESS: 3S 7 IV 4-/r✓ - PERMIT# NEW OR REPLACEMENT INSTALLATION: Project Value$ TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY Bathtub 2- Septic Tank&Pit Clothes Washer I Shower l Dishwasher I Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet Z Hose Bibs 3 Urinal Kitchen Sink l Vacuum Breakers Laundry Tray Water Connected Appliances I Lavatory 2... Water Heater I Other Fixtures Water Treating System bbj RE-PIPE: 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 MISCELLANEOUS: ❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans) ❑ Lawn Sprinkler System-Number of Heads ❑ Well ** **SIRWD 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 the provisions of any other st gto or local law regulation construction or the performance of construction. 6S Property Owners Name S 4 C✓f 'H / © -f�0 Phone Number Plumbing Company P Lv i"1 1, - ,,t, Office Phone YL- ga4 Fax Co. Address: /72 8 $9&L6" A(n, 1 , City -fix - State{q. Zip 32 License Holder(Print): or) 'c I,A.teL CAA 1a P/L— State Certification/Registration# CfC oS74,75- Notarized Signature of License Holder _GIP-rt Air "0s� Notary Public State of r" a this o • of �� 20 /3 Shirley L Graham ' . of My Commission FF 0885>� nat; e of Notary Publi it 11"" 4■, 4 -#.7„.0* Expires 02/14/2018