1733 ATLANTIC BEACH DR - PLUMBING C. 1 \1. CITY OF ATLANTIC BEACH
s1 800 SEMINOLE ROAD
r ATLANTIC BEACH,FL 32233
m -_LLB.;,
INSPECTION PHONE LINE 247-5814
1
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-777
Job Type: PLUMBING ONLY
Description: PLUMBING - 24 FIXTURES
Estimated Value:
Issue Date: 4/1/2016
Expiration Date: 9/28/2016
PROPERTY ADDRESS:
Address: 1733 ATLANTIC BEACH DR
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: NELSON PLUMBING CO. INC.
Address: 11624 -1 DAV E DAVIS CREEK RD QA SCOTT GARY
NELSON
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $168.00
Trade Permit Base Fee $55.00
Total Payments: $227.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 37233
Ph(904)247-5826 Fax(904)247-5845 1( -P(_isr _-777 7
Jos ADDRESS: 1133 ATLAnlrtL IPEOct( DL PERIVIIT# /4-A1-4174
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE - QTY TYPE OF FIXTURE QTY
Bathtub I Septic Tank&Pit
Clothes Washer Shower
Dishwasher I Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet —
Hose Bibs 3 Urinal
Kitchen Sink ____ Vacuum Breakers
Liumdry Tray Water Connected Appliances �—
Lavatory Other Fixtures 9 Water Heater I
_I_ 1 Water Treating System _t___RE-PIPE: V
TYPE OF FIXTURE QTY TYPE OF FIXIVRE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Slibwer Pan
Drinking Fountain Slop Sink
Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal -
- Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Other Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement 0 Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of pia
❑ 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
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 i tEL R S)DE 0 in ES Phone Number
Plumbing Company -A//ELSor/ PLtimgM16 eo ZNC Office Phone fog. 26Z.'Noy Fax
Co.Address: I b 74-1 )A 1 ► 'lc-- 5 4 C' TA Co,w (jt: state a zip 3?.ZS(
License Holder(Print): 0 (cCe'V iwipij, / - i - :a cation/Registration# 0 29 377 v e Holder Ii, •
.4'Pikt, USA P.BASS " �
_.: .•� ..: MY COMMISSION t;F 900342 Sworn and subscribed before me c31 der of`Ill t i t_C.C/\-- 20
-.V.,-10 EXPIRES:November 16 2019 /
�`�/j�.^,�:+'-` 8aided Thru Notary PubNe Underwriters � l.�',/
_ Signature of Notary Public 1& '