751 ATLANTIC BLVD #3 - PLUMBING ' '' s A CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
-f" 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-846
Job Type: PLUMBING ONLY
Description: BACK FLOW BAILEY'S GYM
Estimated Value:
Issue Date: 4/11/2016
Expiration Date: 10/8/2016
PROPERTY ADDRESS:
Address: 751 ATLANTIC BLVD UNIT 3
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: MASTER PLUMBING OF JAX. INC.
Address: 5514 BURDETTE AVE QA DAREL GENE POWELL
Phone: - -
FEES:
Trade Permit Base Fee $55.00
State PLMG DCA Surcharge $2.00
State PLMG DBPR Surcharge $2.00
Plumbing Fixtures $7.00
Total Payments: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
3 PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: 7 5 3 A t PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$ 3 Sp. W
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 give authority to violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name 2.-1/4 y c / /10 ast. G v svt Phone Number
Plumbing Company rY)M For Plum, bny df J/+c Office Phone 74/Y-9./IS Fax 7yy-9/9O
Co.Address: 55/y I✓,4-dc/`/r //�� City JA. State Fl Zip 32-?//
License Holder(Print): ec,C G. i4, fn.ru'/ State Certification/Registration# o4F3.
Notarized Signature of License Holder ,,, v�
Before me this it day o p
4V.P.6111 O r
R4�� Notary Public State of Florida tim
,4 (1 Shirley L Graham Signature of Notary Public _.�.�
My Commission FF 086990 `
°jFOF*�ao- Expires 02/14/2018