1840 ATLANTIC BEACH DR - PLUMBING -S r
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-555
Job Type: PLUMBING ONLY
Description: 23 FIXTURES NEW SERVICE
Estimated Value:
Issue Date: 3/7/2016
Expiration Date: 9/3/2016
PROPERTY ADDRESS:
Address: 1840 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 $161.00
Total Payments: $220.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
�7
( PLUMBING PERMIT APPLICATION
u b CITY OF ATLANTIC BEACH
1 �
800 Seminole Rd Atlantic Beach, FL 32233
, I Ph(904) 247-5826 Fax (904) 247-5845
• JOB ADDRESS: Ls?yo gTc19�f'c / 6 cf( Dr_ PERMIT# it,- 715
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub _J___ Septic Tank&Pit =
Clothes Washer Shower
Dishwasher I Shower Pan a-
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 3
Hose Bibs 3 Urinal
Kitchen Sink 1 Vacuum Breakers '
Laundry Tray ___L__ Water Connected Appliances ___A___
Lavatory __ Water Heater __I_ Z�
Other Fixtures Water Treating System _I__
RE-PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTR'
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher grower Pan
Drinking Fountain Slop Sink
4 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
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 g l v e�s i,D, (C d m ES Phone Number
Plumbing Company /I 75 on/ ktiA,gi't/(a 1-/c, Office Phone fog. 261 y84(( Fax
Co.Address: 11191(( ( 9 i i c ee.,,, . f ZD i City S i,(te State �C_ Zip 32-14
License Holder(Print): ) e / L [ ?J ,.I State Certification/Registration# 02,0 3-7 1,
r---4;;;!,,,,t: ` «; '-- _ f• ;NE .. -. . eHolder I I
I.: ,,, MY COMMISSION t FF 900342 day O f 2
•.l o= EXPIRES:November 16,2019 Sworn and u .cribed be or; me .. i ijf„Ri iii' Bonded Thru Notary Pubic U trwi0en<
Signature of Notary Public ■ — --