2244 FAIRWAY VILLAS LN - PLUMBING � ' y
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� CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J T 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-1099
Job Type: PLUMBING ONLY
Description: PLUMBING - REPLACE WATER HEATER
Estimated Value: $800.00
Issue Date: 5/11/2016
Expiration Date: 11/7/2016
PROPERTY ADDRESS:
Address: 2244 N FAIRWAY VILLAS LN
RE Number: 169398-1114
PROPERTY OWNER:
Name: MIRANDO, CAROL
Address: 210 PINE ST
GENERAL CONTRACTOR INFORMATION:
Name: F.W. FAIR PLUMBING CO.
Address: P O DRAWER 51558 QA FRED FAIR
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $7.00
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.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904)247-5826 Fax (904) 247-5845 i +
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JOB ADDRESS: 7' `I ji4 1g(A)A7d Uj PERMIT#
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NEW OR ' PLACEMENT ■ TALLATION: Project Value $ if pd
} TYP s - ' URE 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 off any other state or local law regulation construction or the performance of construction..
Property Owners Name 6/(0 G /2(R ,0 1 U Phone Nun 9- Z 7i7" lir `
Plumbing Company Ll ) ��/1 "di/ii?/V ( Office Phon0 Vt. 71 'W Fax /-2 7 3
Co. Address: A. .-43kx s-, C' C ,/Q Stag'` Zip�Z 2' 11b
License Holder (Print): JQ i1t A s : rttf cation/Registratioi O 3.7 S
Notari • '---------------;;.-- '-Ider •`1iøhis3PjjfL A��"
!,,,:,;:ii,..., TOM. , B.RO i. rr//MVCAMMISS10NtFFS24951 sworn and subscribed before A 2ge
z.�i,��1 EXPIRES:o p unae tiwrirors
Y ��' BOfIdEd'Mu P1012�/
ignature of Notary Public , _ ��
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