1711 Maritime Oak Dr - Plumbing 19 Fixtures =� J tr-
11111 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247 -5814
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PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814
JOB INFORMATION:
Job ID: 16 -PLBG -369
Job Type: PLUMBING ONLY
Description: 19 FIXTURES
Estimated Value:
Issue Date: 2/16/2016
Expiration Date: 8/14/2016
PROPERTY ADDRESS:
Address: 1711 MARITIME OAK DR
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:
Trade Permit Base Fee $55.00
State PLMG DCA Surcharge $2.00
State PLMG DBPR Surcharge $2.00
Plumbing Fixtures $133.00
Total Payments: $192.00
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
Ph (904) 247-5826 Fax (904) 247 -5845
JOB ADDRESS: 1l 1 1 . ock-dmt-- d 6 1.- ( � 1)2_ Lora ( l( PERMIT # I6 -- 5(L —Ik0
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 1 Septic Tank & Pit
Clothes Washer ] Shower 1
Dishwasher 1 Shower Pan 1
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 3
Hose Bibs __I— Urinal
Kitchen Sink ______ Vacuum Breakers
Laundry Tray Water Connected Appliances — 1 —
Lavatory — IT — Water Heater 1
Other Fixtures ____L__ (A( Water Treating System 1
1
RE -PIPE:
TYPE OF FIXTURE QTY 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:
o Sewer Replacement 0 Back Flow Preventer o Grease Interceptor (Trap) gallons (Requires 3 sets of pia
o Lawn Sprinkler System - Number of Heads o 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
thi< application and know the same to be true and correct All provisions of laws and ordinances governing this work will be complied with whether specii
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 constructio
Property Owners Name � V'E(t -51 DE f O M ES Phone Number
Plumbing Company NELS OA/ PUtA wl R Irk, L & Ji(.Office Phone 90 it 112. gbet /Fax t. _.___._
116 Z — 1 DAVIS £ REC k- 2,o E Ci I, it (Alt/ i 11 State k Zip g�56
Co. Address:
License Holder (Print): SOOT / V/FL—Sort/ 4 4 t; I_ I .4 I cation/Registration #
N ; t , 'w yy,,,.�; S' ieense older
r. Y COMMISSIO k F 900342 ' . 1 1
^. EXPIRES: November 16, 2019 ojL
' L- C— CP ' � •;.•' Bonded Thru Notary Public Underw
Sworn and subscri - d . efore me this s day of
Signature of Notary Public