375 Seminole Rd - Plumbing 2 Fixtures - S !- j\J'
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-./ ;i--- _ CITY OF ATLANTIC BEACH
S l 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
1.7 -0.21 9 '`'
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814
JOB INFORMATION:
Job ID: 15 -PLBG -2953
Job Type: PLUMBING ONLY
Description: PLUMBING -2 FIXTURES
Estimated Value: $750.00
Issue Date: 12/29/2015
Expiration Date: 6/26/2016
PROPERTY ADDRESS:
Address: 375 SEMINOLE RD
RE Number: 170435 - 0000
PROPERTY OWNER:
Name: LOPEZ TRUST, IRIS M
Address: 5824 REBA ST
GENERAL CONTRACTOR INFORMATION:
Name: AMERICAN PLUMBING CONTRACTORS
Address: 5720 ARLINGTON RD QA RANDOLPH EROL MILLER
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $14.00
Trade Permit Base Fee $55.00
Total Payments: $73.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
y� Ph (904) 247 -5826 Fax (904) 247 -5845 -P L Q� _ .Zc, S3
JOB ADDRESS: 31 5 St-n PERMIT #
NEW OR REPLACEMENT INSTALLATION: Project Value $ 7(.5c-/ -
TYPE OF FIXTURE QTY TYPE OF FIXTURE Q TY
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 Q TY 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 **
** SIRWD 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 L/ fr1/ '. �� y Phone Number 7
Plumbing Company Aryl e-rrz ery ' e( ✓ ikt. (17 l S
w�`L�Off Phone `l An3 Fax 4o(1 '7Y- 3
Co. Address: 5'22 o Ph -r " City N44. State P-- Zip 322 fl
License Holder (Print): o ar _ /�_ _ �s ,2 State Certification/Registration # Cie it-WrCil ,
N n se � I older
; - Y COMMISSI Y FF 9249 1 51 _
EXPIRES: October 6, 2019 '
�,i,.'t IN ° Bonded Tim Notary Public Underwriters ; Before me this z day o
Signature of Notary Public TWA _