289 PINE ST 16-PLBG-1014 water heater permit 'S, CITY OF ATLANTIC BEACH
`� ' f
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-1014
Job Type: PLUMBING ONLY
Description: PLUMBING -WATER HEATER
Estimated Value:
Issue Date: 5/2/2016
Expiration Date: 10/29/2016
PROPERTY ADDRESS:
Address: 289 PINE ST
RE Number: 170560-0000
PROPERTY OWNER:
Name: ARCHER, PAMELA A
Address: 289 PINE ST
GENERAL CONTRACTOR INFORMATION:
Name: ATLANTIC COAST PLUMBING CORP.
Address: 3653 REGENT BLVD APT 305 QA NICHOLAS ARLON
PARRISH
Phone: 904-997-3278
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $7.00
Work W/O Permit Plumbing $0.00
Trade Permit Base Fee $55.00
Total Payments: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
05/02/2016 12:10 FAX 9046459363 atlantic-coast Z 001.001
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-584 I Co - PLED. -- 10 (, 4--
JOB ADDRESS: q PERMIT#
•
NEW OR ' Di'LAC'k vIEN'I ALLATION: Project Value$
TrPEorFIXTURE' err TYPE OF FIxrt'Rs QTY
Bathtub Septic Tank 4C Pit
Clothes Washer Shower "�
Dishwasher -""�"
Drinking Fountain Shower Pan "—�
Floor Drain Thy Compartment Sink
Floor Sink Toilet
He Bibs Urinal
Kitchen Sink .,,!_� Vacuum Breakers _
Laundry Tray Water Connected Appliances
Lavatety Water Heater =__
Other Fixtures Water Treating System
RE PIPE:
TYPE OF FIXTURE VT TYPE OF FIXTURE Q7r
Bathtub septic Tank&Pit
Clothes Washer
i Dishwasher Shower Pan _Drinking Fountain S Sink --
Floor Drain Three Compartment Sink
Floor Sink Toilet —
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers —
Laundry Tray Water Connected Appliances
Lavatory Water Her
Other Fixtures Water Treating System ._..._
MISCELLANEOUS:
0 Sewer Replacement D Back Flow Preventer 0 Grease Interceptor(Trap) gallons(Regains 3 sets of plues)
a Lawn Sprinkler System-Number of Heads o Well *+
rr'SJRWA Well Completion Form.Completed form to be submitted to the Building Department for final lnapcction."
0 Other
rr
Permit bccotnes vei WY work dons not comma=within a six motxb period or work is suspended or obwndoned for:ttx months,I booty certify that I have read
this application and know Ow same to ha rres and comet. All provisions of Taws and odinenoes governing this work will be complied with whether speoi Mk
or nor. The penult does not eve attdiwity W violate the txwisiotts of any other state or local kw regulation coaatruaiat or the performance of CQRStrUCtion.
Property Owners Name PQ:vii eita. /CAka? Phone Number 14 03~ 53 2 l
Plumbing Company, `DA Yt'-1 G C.Q A.Sk 191 .,(-m b'it/10 Office Phone - 2) Fax (QLl S-q 31P
Co.Address: 3�0 5 f 2i -Wt lir a ' ) city daGV-5ir1 uj 1(2 stets r"L zip 3.2-72:"1
License Holder(Print): V l 1 O( AS PAP. 4 State r , calaionmegistration# CFC.,05 0 5 ci 0
Notarized Signature of License Holder, _ .. fP
il Before me this j,..." day day of M 2/ ri___,
� zyc�.n1Dy DIANE o, lt0 ooF��e
ec exmrtgs sZi;2t,20 7 Signature of Notary Public
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
PHONE (904) 247-5855
Cashier Id: aspcust\atlbbja
Receipt Date: 5/2/2016
Receipt Number: OS-69805
Job ID: 16-PLBG-1014 - PLUMBING - WATER HEA
TER PDBPR - State PLMG DBPR Surcharge $2.
00
Job ID: 16-PLBG-1014 - PLUMBING - WATER HEA
TER PDCA - State PLMG DCA Surcharge $2.00
Job ID: 16-PLBG-1014 - PLUMBING - WATER HEA
TER PL1 - Plumbing Fixtures $7.00
Job ID: 16-PLBG-1014 - PLUMBING - WATER HEA
TER TP - Trade Permit Base Fee $55.00
Amount Due: $66.00
Tender Information: Cash $66.00
Tender Type: CC
Tender Amount: $66.00
Change Due: $0.00
CITY OF ATLANTIC BEACH