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1662 MARITIME OAK DR - PLUMBING Li-v-1- ff� r� .' . 's, CITY OF ATLANTIC BEACH j 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-868 Job Type: PLUMBING ONLY Description: 23 FIXTURES NEW PLUMB Estimated Value: Issue Date: 4/13/2016 Expiration Date: 10/10/2016 PROPERTY ADDRESS: Address: 1662 MARITIME OAK 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: Trade Permit Base Fee $55.00 State PLMG DCA Surcharge $2.00 State PLMG DBPR Surcharge $2.00 Plumbing Fixtures $161.00 Total Payments: $220.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH � ^ llie? ,800 Seminole Rd Atlantic Beach, FL 32233 I lll f A Ph(904) 247-5826 Fax (904) 247-5845 t Ui JOB ADDRESS: (((02- M ftQ-t T ivrE OM- DA- PERMIT# I Cr SR-- Zn— NEW OR REPLACEMENT INSTALLATION: Project Value$ TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY Bathtub _ Septic Tank&Pit Clothes Washer I Shower —� Dishwasher ___I_— Shower Pan 1 Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet __ _ Hose Bibs Urinal Kitchen Sink Vacuum Breakers Laundry Tray _i Water Connected Appliances —1--- Lavatory _r Water Heater Other Fixtures I Water Treating System RE-PIPE: D 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 give authority to violate the provisions of any other state or local law regulation construction or the performance of construction. • Property Owners Name E1 veta.6 OE 14 O NES Phone Number Plumbing Company AIEl.S o'v Pc t4 rn6 a N G CD 1-,„,. Office Ph• e *Y 2L2.VOW Fax Co. Address: 11 .2t(- 1 ' S '_:i; ' 0 A if;ity41) AStlrtv(1C State 4L Zip 32-2-cc License Holder(Print): Se B'Tr- /1k CS c ki /,/.tail(ficationJRegistration# b2,0311 1 Notarized Signature of License Holder 0 :'��*'`''-, USA P.BASS 5 day of f G 0 20 ( Lc '' ; Before me this // :.; ..� :«: MY COMMISSION k FF 900342 :rtr .b= EXPIRES:November n wr Signature of Notary Publ�_ /� ��.,p,���;�' Bonded Thru Notary Pubfic Underwriters • _� 9 I •