1619 SELVA MARINA DR - PLUMBING sr �L`J .
J
�S� CITY OF ATLANTIC BEACH
tb. .y 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-623
Job Type: PLUMBING ONLY
Description: 2 FIXTURES
Estimated Value:
Issue Date: 3/15/2016
Expiration Date: 9/11/2016
PROPERTY ADDRESS:
Address: 1619 SELVA MARINA DR
RE Number: 171992-0000
PROPERTY OWNER:
Name: BRENNAN, THOMAS E III
Address: 1619 SELVA MARINA DR
GENERAL CONTRACTOR INFORMATION:
Name: WILLIAM'S BIG BOY PLUMBING INC
Address: 516 SOUTH 11TH AVE QA WILLIAM WAGNER GOODLING
Phone: - -
FEES:
Trade Permit Base Fee $55.00
State PLMG DCA Surcharge $2.00
State PLMG DBPR Surcharge $2.00
Plumbing Fixtures $7.00
Total Payments: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845
/LWq Jos ADDRESS: S fl ' Az" PERMIT
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE
Bathtub QTY
Clothes Washer Septic Tank 8c Pit
Dishwasher Shower
Drinking Fountain Shower Pan
Floor Drain Slop Sink
Floor Sink Three Compartment Sink
Hose Bibs Toilet
Kitchen Sink Urinal
Laundry Tray Vacuum Breakers
Lavatory Water Connected Appliances
Other Fixtures Water Heater
Water Treating System
RE-PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE
Bathtub QTY
Clothes Washer Septic Tank&Pit
Dishwasher Shower
Drinking Fountain Shower Pan
Slop Sink
Floor Drain
Floor Sink Three Compartment Sink
Hose Bibs Toilet
Kitchen Sink Urinal
Laundry Tray Vacuum Breakers
Lavatory Water Connected Appliances
Other Fixtures Water Heater
Water Treating System
MISCELLANEOUS:
o Sewer Replacement Cl Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well **
**SJRWD Well Completion Form. Compleet/ed form to be submitted to the Building Department for final inspection.**
Other Nov()v( W aS1&4 /k/9 10 ,6 �'5 6: vaf P
Per mit 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 /00,4
i�reN�a ,if Phone Number
Plumbing Company 4r l M o-1;d - h c7 g7 Office Phone 21f(( $ Fax
Co. Address: 5.75.74,� fill AV , S / � 56....)C
City 14 State .Zip S22.5 6
License Holder(Print): LJ ti(t k"^-^- 600()L-lw ei State Certification/Registration# 9 f- 4064 ?O
Votarized Signature of License Holder 3•xev"oe Notary Public State of FloriBefP e me this I da _ '� ' /_Shirley ■
L Graham
9` ` Sh Commission FF 08899 t�
'torso ' Expires 02/14/2018 °Sig r ture of Notary Publ. ,,_ � i.
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