1089 ATLANTIC BLVD - PLUMBING r ✓( ‘,
�' ,.;,s, CITY OF ATLANTIC BEACH
Iii •A ~ j Si 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: 16-PLBG-250
Job Type: PLUMBING ONLY
Description: 21 FIXTURES
Estimated Value:
Issue Date: 2/2/2016
Expiration Date: 7/31/2016
PROPERTY ADDRESS:
Address: 1089 ATLANTIC BLVD
RE Number: 177616-0000
PROPERTY OWNER:
Name: ASHLAND INVESTMENT, INC.
Address: 7880 GATE PKWY SUITE 300
GENERAL CONTRACTOR INFORMATION:
Name: COUF PLUMBING LARRY COUF
Address: 1104 Wood Hill PL
Phone: - -
FEES:
Plumbing Fixtures $147.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $206.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION ��
CITY OF ATLANTIC BEACH 6 - Z
800 Seminole Rd Atlantic Beach, FL 32233 l 6 . /9116
Ph(904) 247-5826 Fax(904) 247-5845
4 in
JOB ADDRESS: 1 U ( Af1an�%k 1J(ucX PERMIT# I S—CAY"j—ig 7
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub i Septic Tank&Pit
Clothes Washer I Shower t
Dishwasher I Shower Pan
Drinking Fountain Slop Sink
Floor Drain 9 Three Compartment Sink _
Floor Sink Toilet 5.
Hose Bibs a. Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray 1 Water Connected Appliances
Lavatory 15 Water Heater 1
Other Fixtures \ - Water Treating System
RE-PIPE: C
TYPE OF FIXTURE QTY Y 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 65'63-;3 46
Plumbing Company Cc r f t "I'? Office Phone Fax
Co. Address: I(U'-( L,✓cicIi?;/( PL City `,AIX State fL Zip S 29'1C
License Holder (Print): Lie.,'./ Ca`J C State Certification/Registration# CPC) 1 .'1l+-/I
Notarized Signature of License Holder 4II)_
fore me this d. . of a / I�U_
PO* Notary Public State of Florida . .
: ; Snir!ey t_Granam �' r
�y, N lvty Commission FF 086990 S' ,nature of Notary Publi a _�� ,
?pf�0� Expires 02/14/2018
' .