167 MAGNOLIA ST - PLUMBING J' r-
CITY OF ATLANTIC BEACH
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SJ 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-PLBG-2623
Job Type: PLUMBING ONLY
Description: PLUMBING - 9 FIXTURES
Estimated Value: $1,400.00
Issue Date: 11/4/2015
Expiration Date: 5/2/2016
PROPERTY ADDRESS:
Address: 167 MAGNOLIA ST
RE Number: 170625-0500
PROPERTY OWNER:
Name: ATKINSON, W R
Address: 5666 WELAKA CT
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $63.00
Trade Permit Base Fee $55.00
Total Payments: $122.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACII ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233 ( S-P L ( 6- Z-6025
Ph(904) 247-5826 Fax (904) 247-5845
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JOB ADDRESS:
l(P 1 in a 1 oI t o S� �� ' 00 of S-OSdo PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$ 1 400
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub ___1_ Septic Tank& Pit
Clothes Washer Shower ___i___
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: 4
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower _-I—
Dishwasher ___L— Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Al
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray I Water Connected Appliances
Lavatory Water Heater I
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 ii 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 P i-k,s Y\srYl J W A Phone Number 112 50(0 413 a-7
Plumbing Company kyv.e.sk U-G TOLL 355 goo I Office Phone f Oq 97 91°Fax 6/dLi a l P.1(91
GOA
Co. Address: 533 £- rc,h 4 a `&e 4 City <.* Stated Zip S-2-7-67
License Holder(Print): RQ t CO- d& 11 , State Ce 'fication/Registration# CFC, 1 W)i ti
Notarized Signature of License Holder
Xv_., 9/31/4
o��":°��,� usACRAWFORD Sworn and !Fri.ed befor. : this act day of 0 40 � 20 13
r ' MY COMMISSION 9 FF 192391 i
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* ``Ti� * EXPIRES:January 25,2019 Signature of Notary PublicCL�.:� ._.► l.•
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ru Budget Notary Strides