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892 OCEAN BLVD - PLUMBING CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD j, " ATLANTIC BEACH, FL 32233 INSPECTION PHONE LINE 247-5814 \Jiil�r PLUMBING PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 15-PLBG-2264 Job Type: PLUMBING ONLY Description: PLUMBING - 11 FIXTURES Estimated Value: Issue Date: 9/28/2015 Expiration Date: 3/26/2016 PROPERTY ADDRESS: Address: 892 OCEAN BLVD RE Number: 170344-0000 PROPERTY OWNER: Name: HARRIS, ROBERT L Address: PO BOX 40126 GENERAL CONTRACTOR INFORMATION: Name: AMERICAN PLUMBING CONTRACTORS Address: 5720 ARLINGTON RD QA RANDOLPH EROL MILLER Phone: - - FEES: State PLMG DBPR Surcharge $2.00 State PLMG DCA Surcharge $2.00 Plumbing Fixtures $77.00 Trade Permit Base Fee $55.00 Total Payments: $136.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph(904)247-5826 Fax(904) 247-5845 ( 5°P L 66 --zz(/ LOB ADDRESS: 1.2. (Jew g?004 PERMIT# NEW OR REPLACEMENT INSTALLATION: Project Value$ eVicos Ob 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 1 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 1 Septic Tank&Pit I. Clothes Washer Shower Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sink ___r_ Floor Sink Toilet Hose Bibs Urinal Kitchen Sink Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory S 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 the provisions of any other state or local law regulation construction or the performance of construction. C Vey �•C.CZs Phone Number S.-K-('233 Property Owners Name ■ Plumbing Company cuu.:/ ..:. ,_ AAA = .. t!_Ll . • Office Phone 1 i -/(o'1 3 Fax/4-4��' City �A y _State 1�r r Zipp2�-1, Co. Address: ��� �6Z'"•' `— License Holder (Print): State Certification/Registration#C c''C,0 Si.Trit Notar "'' KIM LASSIAT • • 'µ',.,,F,.,, 2015 . ;�, . Notary Public-State of FI$i7I .11 and subscribed before ii.s % day of • : A. My Comm.Expires Apr 8,2016 -ll y• Q.„ Commission # EE 1751 M_ ,tore of Notary Public J °'' ''''� Bonded Through National Notary As .