871 SHERRY DR - PLUMBING (2) `fr !; CITY OF ATLANTIC BEACH
s) 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-2625
Job Type: PLUMBING ONLY
Description: WATER SOFTNER
Estimated Value:
Issue Date: 11/4/2015
Expiration Date: 5/2/2016
PROPERTY ADDRESS:
Address: 871 SHERRY DR
RE Number: 169982-0000
PROPERTY OWNER:
Name: PALMER ET AL, CHRISTY L
Address: 871 SHERRY DR
GENERAL CONTRACTOR INFORMATION:
Name: AFFORDABLE WATER/KINDER INC
Address: 3760 KORI RD SPECIALTY WATER (CONS TDS QB)
Phone: - -
FEES:
Trade Permit Base Fee $55.00
Plumbing Fixtures $7.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Total Payments: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND TIIE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH /s' Pi ea
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax (904) 247-5845 !—t/ Z5.
JOB ADDRESS: Sri I 'he R R TDR1 EI lie Lai f is i3eath PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$ LD(p.
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 —I
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 **
**STRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ Other
4
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 �1 K lb U PF Phone Number 372 77g('
goy- 904-
Plumbing Company AFFoROAP LE WAT£2 Office Phone 242-0I 91 Fax 240—(0292
Co. Address: 3'16 0 K o R i ROA 1) City c Ks o n t i t I e State FL Zip 3 2251
License Holder(Print): A • . a • • . State Certification/Registration# 000 8 18 6
Notarized Signature of License Holder . _
Notary Plc SUM a Florida
Sworn and subscribed bef e this A-c day of � rro i�L 20 6
iMy m 854361 Signature of Notary P lic ►\'l1^!L�
ptr Expires 02/09912017