642 Aquatic DR water heater CITY OF ATLANTIC BEACH
f 800 SEMINOLE ROAD
j 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-2580
Job Type: PLUMBING ONLY
Description: WATER HEATER
Estimated Value:
Issue Date: 11/6/2015
Expiration Date: 5/4/2016
PROPERTY ADDRESS:
Address: 642 AQUATIC DR
RE Number: 171818-5214
PROPERTY OWNER:
Name: VITEK, KIMBERLY ANN
Address: 642 AQUATIC DR
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 THE FLORIDA
BUILDING CODES.
To: Page 4 of 4 2015-10-30 20:10:53(GMT) 18885119039 From: Stacy Haga
Oct 3015 04:10p Southeast Home Solutions 904-247-0535 p.1
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
1, god Seminole Rd atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904) 247-5845
JOB ADDRESS: ll,s:v,, *� t�- R 111#
NEW OR REPLACEMENT INSTALLATION: Project Value
TYPE of FixTuAE QTf' TYPE oFFrxz'rrm QT'
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan �+
Drinking Fountain Stop Sink r�
Floor Drain Three Compartment Sink q
Floor Sink Tort V
Hose Bibs Urinal
Kitchen Sink Vamum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System y O
RE PIPE:
TYPE oFFIXTGRF_ QTY TYPE or Fu-arRE QTY � 4
Bathtub Septic Tank&Pit
CItrthes Washer
Shower
Dishwasher Shower Pan
Drinking Fountain. Slop Sink
Floor Drain Thiee Compartment Sink
Floor Sink _ Toilet
Hose Bibs Urinal
Kitchen Sint: Vacuum Breakers
Laundry Tray Water Co anected Appliances Q�
Lavatory Water lleater
Other Fixtures Water Treating System _ -
MISCELLANEOUS:
-.3SeAer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gztllons(Requires 3 seas of plans)
Ci Lawn Sgrinller System Number of Heads
❑ Well
* SJRWD Well Completion Form. Completed form to be submitted to the Bui]ding Department for final inspection_**
❑ Other
Pe.- t becomes void if work does ucc 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 lmow the same to be true and correct. All provisions of laws and ordinances 90vernin91hi3wArk will be complied cath wht tier sp::Wfled
or not, fbe permit does not give authority to violate the provisions of any other state or local law regulalien construction or the performance of constrixtiQn.
Property Owners Name C�;�' ` Phone Number l
Plumbing Company `'f '� t �, -5. Office Phon.e�'"�-� F
� City ' (� `State Zip 3�U,
Co. Address: C_
tits_+tirrt�� }J
T.icease, ��"\� ' ' r;,�• _� � C-.,t��� State Certi€tcafiiarL'Registration#� C' i � �
;Votar0 $; Lrtse Holder Q; Lti
` / 20.
W"f' its: Sworn and subscribed before this_�_ __daY�=
J oma- Signature of Notary Yuhlie '
•.S�j,•.%.Pusr.�G•'� �.
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