1842 HICKORY LN PLBG 2016 CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J " ATLANTIC BEACH, FL 32233
..k.* INSPECTION PHONE LINE 247 -5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247 -5814
JOB INFORMATION:
Job ID: 16 -PLBG -698
Job Type: PLUMBING ONLY
Description: 2 FIXTURES
Estimated Value:
Issue Date: 3/22/2016
Expiration Date: 9/18/2016
PROPERTY ADDRESS:
Address: 1842 HICKORY LN
RE Number: 172020 -1452
PROPERTY OWNER:
Name: DOWLING TRUST, SHIRLEY M
Address: 1 FLEET LANDING BLVD
GENERAL CONTRACTOR INFORMATION:
Name: BILL FENWICK PLUMBING
Address: 11623 E COLUMBIA PARK DR QA WILLIAM K. FENWICK, JR
Phone: - -
FEES:
Trade Permit Base Fee $55.00
State PLMG DCA Surcharge $2.00
State PLMG DBPR Surcharge $2.00
Plumbing Fixtures $14.00
Total Payments: $73.00
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: L 1 L I� ' r l l (, 1r La.,p 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 **
** 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 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 giv thority to viol e provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name \CJUI � I' =-�SC- Phone Number 75 7- - 37 .7-A0(2
Plumbing Company i )�' j1, br Office Phone4D'+ 70.4 Fax7c 7' Ee
Co. Address: 1 16 a,.3 I(,Arnto a.ric &kAJ City U0 (SA State FL Zip s8
S tate Certification/Re istration # CFCO(1 -w37
License Holder (Print): 1 11 EI<% ;l .� . g
Notarized Signature of License Holder
Penny JoSn tt Sworn and s cribed before me this a a day of C`(1c,TC.\ 201 L
NOTARY PUBLIC
CC
�yt ' STATE OF FLORIDA Signature of Notary Public �� ;.rw.• ,Snn
-744t, ' Comm# FF93976d
Expires 11/30/2019