610 Ocean Blvd - Plumbing 31 Fixtures it CITY OF ATLANTIC BEACH
rl ' j 800 SEMINOLE ROAD
*=" ATLANTIC BEACH, FL 32233
ATLANTIC BE
CTION PHONE LINE 247 -5814
PERMIT RECEIPT
PERMIT DESCRIPTION: PLUMBING - 31 FIXTURES
PERMIT NUMBER: 16 -PLBG -325
ADDRESS: 610 OCEAN BLVD
OWNER:
DATE ISSUED:
FEES DUE:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $217.00
Trade Permit Base Fee $55.00
Totals: $276.00
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
‘ c..) p t e4C Ph (904) 247 -5826 Fax (904) 247 -5845 16 -- pf (je _ 325
JOB ADDRESS: 0 / -0 0 CE'A Al Ai v O PERMIT #
/47140A, T it. Q c'i Fl. 32.zg3
NEW OR REPLACEMENT INSTALLATION: Project Value $ 70, aop 4-4.)
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub / Septic Tank & Pit
Clothes Washer Z Shower
Dishwasher �� Shower Pan 1
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet (v
Hose Bibs .3 Urinal
Kitchen Sink 2. Vacuum Breakers
Laundry Tray 2. Water Connected Appliances
Lavatory (e Water Heater 2
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:
i0 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 c.a. SK i t-' N F_ r V R. Phone Number
Plumbing Company HP C Q e n T IA P as Office Phone Co 2 4' ? V z 3 Fax
Co. Address: 43 '' Re Q Ti P IQ D N p r T IN City Ay State F/.. Zip 3 Z Z ■
License Holder (Print): /'Li /4 State Certification/Registration CFC / yx'' 3 (a R'
d Signature o License Holder /,..�. -�
Notarize g f --
i `4.'9ff me a IgINC FGER da •f — A 0 I O
if MY OOMMI ' • •
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v..z3ire i n 6 . 4 : ; e, i1 6�IrA —
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