1810 ATLANTIC BEACH DR - PLUMBING ` ' \ , CITY OF ATLANTIC BEACH
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-554
Job Type: PLUMBING ONLY
Description: 26 FIXTURES NEW SERVICE
Estimated Value:
Issue Date: 3/7/2016
Expiration Date: 9/3/2016
PROPERTY ADDRESS:
Address: 1810 ATLANTIC BEACH DR
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: NELSON PLUMBING CO. INC.
Address: 11624 -1 DAVE 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 $182.00
Total Payments: $241.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
r - 5 PLUMBING PERMIT APPLICATION
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\b- \ U� CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
, n Ph(904)247-5826 Fax (904)247-5845
JOB ADDRESS: I t I 0 AT L.Prp\tri L l E u-( 1)l R- PERMIT# 16-SFR.-257
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTR'
Bathtub 2. Septic Tank&Pit
Clothes Washer I Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 4
Hose Bibs 3 Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray _____IWater Connected Appliances l
Lavatory S Water Heater I r ,
Other Fixtures _iWater Treating System J `fj
RE-PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE Qri
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:
o Sewer Replacement ❑Back Flow Preventer ❑ 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
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
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 specif
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 R1 VE LS!O 44 o Yvv\E3 Phone Number
Plumbing Company /4ELS°AJ p(.0 sl g I i l 6 (o Di✓L Office Phone `trt',Z62.1 be t( Fax , _
Co.Address: 1 162' -1 Oii tl s (22EEIL- S) i i , .-Seit6t)ItAU( State L Zip 3456
License Holder(Print): S .. • A. L /,�', ' 1 !- Certification/Registration# 0 2.0 37t-_
- •--. Holder 1 , d
I, ; co•,y�A ib «fF st ag. .. 3 day of-- G6Lf 2 U('(o r I ,
b bents;2018 Sworn and subscrl•-d before me this ii !A Puy•�
- ___ 1 Signature of Notary Public (. c,.._