312 4th ST - PLUMBING r
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f.:IS ' `' V`� CITY OF ATLANTIC BEACH
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A j 800 SEMINOLE ROAD
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-1028
Job Type: PLUMBING ONLY
Description: 17 FIXTURES
Estimated Value:
Issue Date: 5/3/2016
Expiration Date: 10/30/2016
PROPERTY ADDRESS:
Address: 312 4TH ST
RE Number: 169812-0000
PROPERTY OWNER:
Name: HOLLOWAY ET AL, MARGARET M
Address: 1200 OCEANFRONT
GENERAL CONTRACTOR INFORMATION:
Name: DARLEYS PLUMBING INC.
Address: 4472 PHILLIPS HWY QA CARL LESLIE DARLEY
Phone: - -
FEES:
Trade Permit Base Fee $55.00
State PLMG DCA Surcharge $2.00
State PLMG DBPR Surcharge $2.00
Plumbing Fixtures $119.00
Total Payments: $178.00
PERMIT IS APPROVED ONLY IN ACCORDANCE NVITII ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233 4
Ph(904)247-5826 Fax(904)247-5845 �c"w, S-RAb0 )S-a-(
JOB ADDRESS: 3( a '4--k\--% 5\--, uN\- -la 4 c c le, ;F L. 32 2 3 3 PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub `2.. Septic Tank&Pit
Clothes Washer 1 Shower ______L_
Dishwasher I Shower Pan ____L_
Drinking Fountain Slop Sink
__ ______ 0
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs 2.. Urinal
Kitchen Sink 1 Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory q 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 Phone Number
Plumbing Company Darley's Plumbing Inc Office Phone 904 7271484 Fax 904 7271485
Co. Address: 4472 Phillips Hiwhway City Jacksonville State FL Zip 32207
License Holder(Print): Carl Darley Stat rtificati egistration# CFC056702
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Notarized Signature of License Holder (•k A
_} 3rd
i „.• •••r • Ili,. .,no—,d0eeWE tottr:.•• Sworn and subscribed before e this day of
� =3e.eV-k ��Nataty y 20�(Q
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IV.,6,', grt.My-Cgom.-Expjr s Au, •s; 1 . Signature of Notary Public
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4 '",,,,`,\,.' ;,Qondeif Through National Pi iir Ass
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