659 OCEAN BLVD - PLUMBING \ - ss. CITY OF ATLANTIC BEACH
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-1176
Job Type: PLUMBING ONLY
Description: PLUMBING - WATER HEATER
Estimated Value: $1,000.00
Issue Date: 5/23/2016
Expiration Date: 11/19/2016
PROPERTY ADDRESS:
Address: 659 OCEAN BLVD
RE Number: 170127-0000
PROPERTY OWNER:
Name: HEYMAN, JONATHAN T
Address: 659 OCEAN BLVD
GENERAL CONTRACTOR INFORMATION:
Name: DAVID GRAY PLUMBING INC.
Address: 6491 S POWERS AVE QA DAVID FRED GRAY
Phone: - -
FEES:
Trade Permit Base Fee $55.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $7.00
Total Payments: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACII ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION •
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233 i 6 —P L6 _ ( f? c
Ph (904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: ( 5q O(7eaii 6 / (4,47r � � �-YERMIT#
00
NEW OR REPLACEMENT INSTALLATION: Project Value $ /000
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 0 Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
o Lawn Sprinkler System-Number of Heads ❑ Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ Other ar)f 1—mo'
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 17 violate/ the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name /C( a� y‘.;_y/, Phone90�Number -3`6,)-77
Plumbing Company�� 1/I f�Gt.? /?t Office Phone %n -7 Y-7ZfIFaxg0(/'T��591Zc
Co. Address: ID T!/ pOt.1/4)t r City J664 54--)w/k Staten Zip 3 /7
License Holder (Print): State Certification/Registration # CFC9c2..2Sg
Notarized Signature of License Holder UZI %kr(
Notary Public state r' w worn and subscribed before me this day of Irl 20/
Ce
;-4. Wendy Rayle
,t.1i
My Commission FF 'sso/s �1g Notary nature of Public Ut ' 4
or*o" Expires 08/17/2018