592 Timber Bridge Ln - Plumbing - 30 Fixtures - S
SA CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
t) 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 -2954
Job Type: PLUMBING ONLY
Description: PLUMBING - 30 FIXTURES
Estimated Value:
Issue Date: 12/29/2015
Expiration Date: 6/26/2016
PROPERTY ADDRESS:
Address: 592 TIMBER BRIDGE LN
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: NELSON PLUMBING CO. INC.
Address: 11624 -1 DAV E DAVIS CREEK RD QA SCOTT GARY
NELSON
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $210.00
Trade Permit Base Fee $55.00
Total Payments: $269.00
1
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 5
Ph (904) 247 -5826 Fax (904) 247 -5845 � -
y P Zc 5 4_
JOB ADDRESS: qqd- TTi m,BE2- ga D(E ZAJ PERMIT' # /.S S - Cr- 273y
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub _ Septic Tank & Pit
Clothes Washer _I___ Shower
Dishwasher ___L__ Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 14
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray __1_ Water Connected Appliances 1
Lavatory b - Water Heater a
Other Fixtures Water Treating System 1
RE -PIPE: /1)
TYPE OF FIXTURE Q TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer Shower
Dishwasher Slibwer 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 pia
❑ Lawn Sprinkler System - Number of Heads ❑ Well . **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection
D 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
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 specif
or not. The permit does not give authority to violate the provisions regulation c
s of any other state or local law regulationstruction or the performance of constructio
Property Owners Name l� l VE2St 0, tt om&- -; Phone Number
Plumbing Company /VC (-So. PLUV1 b /iY() Office Phone q0'( Z6Z '(a Fax r
Co. Address: /1 (o i ll —1 Po ✓ ((lee s 2 Z o e City S ft On til i Ile State i L Zip ►Z1S
License Holder (Print): > (..° Tr /1/ • "l � �
S. - CertificationfRegistration # C ? t} 2 3 ri ct
o s. Solder _.�fI % . I - i -
' ' : MY COMMISSION # FF 900342 ' _)j d ay ,� _ �LV 7 (1 /,
a EXPIRES November IS, 2019 Sworn .18 d bscribed before me A
''Z; of n' Bonded thru Notary Public Underwriters Signature C� ' / v
Signature of Notary Public