172 POINSETTIA ST - PLUMBING , `r 1ri .
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`Ss. CITY OF ATLANTIC BEACH
1
1 _-:k;1,h, ,,:- ;) 800 SEMINOLE ROAD
;6 =" ATLANTIC BEACH, FL 32233
\ INSPECTION PHONE LINE 247-5814
4-4 9.21 9'
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-PLBG-2656
Job Type: PLUMBING ONLY
Description: PLUMBING - 1 FIXTURE
Estimated Value:
Issue Date: 11/12/2015
Expiration Date: 5/10/2016
PROPERTY ADDRESS:
Address: 172 POINSETTIA ST
RE Number: 170638-0080
PROPERTY OWNER:
Name: HUBBARD. LETITIA
Address: 172 POINSETTIA ST
GENERAL CONTRACTOR INFORMATION:
Name: ALL CARE MAINTENANCE & REPAIR
Address: 14370 S DEMERY DR TIMOTHY W SHIRLEY
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $7.00
Trade Permit Base Fee $55.00
Total Payments: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITII ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax (904)247-5845 1 5 — P f✓16.-Z6 S Cv
Ios ADDRESS: 1 7 2., !-"o 1 n 34, -th w T.
5 PERMIT#
' EW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub i 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
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 ALL CARE SERVICES Office Phone 904-821-0220 Fax
Co. Address: PO BOX 50528 City JACKSONVILLE State FL_Zip 32240
License Holder(Print): RICHARD FAGIANO State Certification/Registration# CFC1429194
Notarized Signature of License Holder c-
,...z:"47.,. SUSAN M FRANK Sworn and subscribed be m 's 10TH day of NOVEMBER 20 15
1N ; t MY COMM.SSIOM1i#FF103245 No Public
_,. .o: Signature of tart' _��
`"•.;m.c.f.:= EXPIRES March 17, 2018
(407)39W-01W FiorldaNetaryServke.com
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