1671 SEA OATS DR - PLUMBING r XL,J,�S, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
- r 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-945
Job Type: PLUMBING ONLY
Description: 1 FIXTURE
Estimated Value:
Issue Date: 4/22/2016
Expiration Date: 10/19/2016
PROPERTY ADDRESS:
Address: 1671 SEA OATS DR
RE Number: 172020-0152
1 PROPERTY OWNER:
Name: BURNS JR, JAMES F
Address: 1671 SEA OATS DR
GENERAL CONTRACTOR INFORMATION:
Name: ATLANTIC COAST PLUMBING CORP.
Address: 3653 REGENT BLVD APT 305 QA NICHOLAS ARLON
PARRISH
Phone: 904-997-3278
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: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORID:k
BUILDING CODES.
04/22/2016 10:26 FAX 9046459363 atlantic-coast Z001
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845
JOB A PAIRtNAS: 7/ 5G &ff "'. PiritMr r#
NEW 0• ili'EPLA t INSTALLATION: Project Value$ 7O0. 0
1"yEEOFFixruRE QTY TYPE OF FIXTURE en
Bathtub Septic Tank&Pit Clothes Washer Shower Pan =
Drinking Fountain __ _. _.. Slop Sink __
Floor Drain Throe Compartment Sink
Floor Sink Toilet
Hose Ribs Urinal _...
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances _
Lavatory ._— Water Heater _
Other Fixtures Water Treating System _
R.E.PIPk',:
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 Fixture: Water Treating System _
MISCELLANEOUS:
0 Sewer Replacement 0 Back Flow Preventer 0 Grease Interceptor(Trap) gallons(R egaires 3 sets of pasts)
❑ Lawn Sprinkler System-Number of Heads ❑ Well **
**SIRWD Well Compkrion Form.Completed orm to be submitted to the building Department fsr final irnspection.**
o Other
Permit bccmms,rold Wwork dons not canna=within a six month or work is stI¢p¢rtded or abandoned for tie reo tarcby cordty that I have road
this apptittdott and know the tame te be moo and oorrcct All pmvistnns ottawt;end otutnasees sovermlas this work wilt be oomptetd with whothet gxiciltcd
or sot.The txtmit does not giw authority lo vlolato the provisions dm other state or local kw regulation son,truetioe or the pr.toucans.of construction.
Property Owners Name .'ran• 4 4- iW'• 8drn S Phone Number, y_L- /01,___
Plumbing Company /1/6i4- 7 //m H e.r y,Office P coo '51 47 S/ Fax 66 fa43
Co.Address:%4-3 :? - 4 vel, w° City fi State/7 Zipf -1
License Holder(Print); A• .' 4..-,._
Stale :'catiotacgistration# of/c,so.5 ,0
Notarized Sigaarure o .r l. Holder A �I��r•l
,,,c n DIANE O.ROF,H Be o me this ' y+� /t �p9958 � �� � �y Qf �! / _ 8‘.0/:_f___
1,�'' h1V COMMISSIOS 4` 2 9_,
, � ;� •Lx�IRes.AID Sigttatttne of Notary Public