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358 19TH ST - WATER HEATER )' ' �S, CITY OF ATLANTIC BEACH f 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-2491 Job Type: PLUMBING ONLY Description: WATER HEATER Estimated Value: Issue Date: 10/20/2015 Expiration Date: 4/17/2016 PROPERTY ADDRESS: Address: 358 19TH ST RE Number: 172020-1234 PROPERTY OWNER: Name: CRUTCHFIELD, AMY Address: 358 19TH ST GENERAL CONTRACTOR INFORMATION: Name: A J MOREL PLUMBING INC Address: 8915 CASTLE ROCK DR ARTHUR JAMES MOREL Phone: - - FEES: Trade Permit Base Fee $55.00 CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD Plumbing Fixtures $7.00 ATLANTIC BEACH, FL 32233 PHONE (304) 247-5855 State PLMG DBPR Surcharge $2.00 Cashier Id: as10/20/2015 1e g Receipt Date: lO/20/2015 11:38:44 AM Receipt Number: 05-68458 State PLMG DCA Surcharge $2.00 Job ID: 15-PLBG-2491 - WATER HEATER TP - T rade Permit Base Fee $55.00 Job ID: 15-PLBG-2491 - WATER HEATER PL1 - Plumbing Fixtures $7.00 Total Payments: $66.00 Job ID: 15-PLBG-2491 - WATER HEATER PDBPR - State PLMG DBPR Surcharge $2.00 Job ID: 15-PLBG-2491 - WATER HEATER PDCA - State PLMG DCA Surcharge $2.00 Amount Due: $66.00 Tender Information: Cash $65.00 Tender Type: CC Tender Amount: $66.00 Change Due: $0.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC REACH ORDINANCES AND THE FLORIDA BUILDING CODES. PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph(904)247-5826 Fax (904)247-5845 JOB ADDRESS: c358 /q ' Sf A-flantic beach FL- 32Z33 PERMIT# NEW OR REPLACEMENT INSTALLATION: Project Value$ c-IS, 00 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 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 _L— Other Fixtures Water Treating System MISCELLANEOUS: • Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans) If Lawn Sprinkler System-Number of Heads ❑ Well ** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.** ▪ Other r • ,. JI -/ A e Dee- wa 1e4'- AL, 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 M l'ke -Gf'rl i Phone Number 96 1F qSI-L.219 Plumbing Company A,J, Mord RI u m bhhg', �nC• Office Phone 90`{-�BYo l)7 q7 Fax q(I y-37 —5198 Co. Address: gi is- cJ SI I lock, �, City ja cicsonvi l le_ State Zip 3,1-d-a) License Holder(Print): A r G re,J / State Certification/Registration# CFC/'�-4O(oO(o Notarized Signature of License Holder ,,:�'P1 OVe•,, 40 A <-0.„ P. CARLILE Sworn an subscged before me this 65' day of t 20 i I MY EXPIRES January#2F084426 Q �o'. EXPIRES January 20,2018 Signature of Notary Public „ /INI (407)398.0153 FloridallotaryService.com