1639 SEA OATS DR - MECH GAS PIPING 6' 1 . CITY OF ATLANTIC BEACH
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s.... ``v 800 SEMINOLE ROAD
j a.`---f: ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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MECHANICAL GAS PIPE PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-MCHG-2339
Job Type: MECHANICAL GAS PIPING
Description: 2 OUTLETS- 3 WATER HEATER
Estimated Value:
Issue Date: 10/5/2015
Expiration Date: 4/2/2016
PROPERTY ADDRESS:
Address: 1639 SEA OATS DR
RE Number: 172020-0136
PROPERTY OWNER:
Name: COLLIER, KEITH D
Address: 1639 SEA OATS DR
GENERAL CONTRACTOR INFORMATION:
Name: KDS VENTURES LLC
Address: 4341 N RED TIP RD KURT SCHLUP
Phone: - -
FEES:
Gas Pipe Outlets $10.00
Gas Piping Units $0.00
State Mech DBPR Surcharge $2.00
State Mech DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $69.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233 s -P C�j J•-z337
Ph(904) 247-5826 Fax (904)247-5845
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JOB ADDRESS: /c//e 3 ? S-r',.4 co),47 c PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower 2- 3
Dishwasher / Shower Pan /
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet V
Hose Bibs '1/ Urinal
Kitchen Sink Z. Vacuum Breakers
Laundry Tray / '7 Water Connected Appliances /
Lavatory = ' Water Heater 3
Other Fixtures Water Treating System
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 **
**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.
Property Owners Name/ Phone Number
Plumbing Company l7 O s' 1J eiyli?':'13 C L. -C-- Office Phone 6 7-Y1123 Fax
Co. Address:/1?e// /ae;/2 %�A fee,/ /UU% T 1 Citylte, CCoivl•t ) State&_Zip 322 a
License Holder(Print): , 12.1 ra44, State •Certification/Registration Fe/"77`3'8
Notarized Signature of License Holder ..,..-"
I efore me this cr da, • At eV 20 /5
Notary Public State of Florida ' -� oft,
L Graham ..ignature of Notary Pub '=
My Commission FF 096990 MO Expires 02/14/2018
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