366 SEMINOLE RD - PLUMBING ' 'a�� CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
\j 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-506
Job Type: PLUMBING ONLY
Description: PLUMBING - WATER SERVICE REPLACEMENT
Estimated Value:
Issue Date: 3/1/2016
Expiration Date: 8/28/2016
PROPERTY ADDRESS:
Address: 366 SEMINOLE RD
RE Number: 170427-0000
PROPERTY OWNER:
Name: ANDERSON, MARY K
Address: 366 SEMINOLE RD
GENERAL CONTRACTOR INFORMATION:
Name: PIPE WORKS LLC
Address: 8430 THORNTON CT QA JOSEPH JACK CONTOIS
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $7.00
Trade Permit Base Fee $55.00
Total Payments: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE. WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
III II I.DING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax (904)247-5845 I Co-PL. _J 0(
JOB ADDRESS: ,56(o Se m not c PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
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
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:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well **
**SIRWD1W1ell•Completion Form. Completed form to be submitted to the Building Department for final inspection.**
G✓Other SeN(Q Q-(00iC -trA
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 'Qtd ft-el d le-e5 1tf Irx ( Phone Number'7 9O 5011 612T"
Plumbing Company Pt(t woks Office Phone 333 07 t el Fax
Co. Address: .3. 401k Pen'h (1- J AY Ci 37/2 ( City Jac kauA„1)t State cl Zip . 2?'?
License Holder(Print): Jac ateciO S State Certification/Registration# �'FCICIS")V2
e o � AL—e d-/ 1
Notarized Signature of License
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,�, ;,� MY COMMISSI�i�FE>�9911C � is � day o �i� � �I\ 20 r EXPIRES:October 6,2019
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