440 GARDEN LN - PLUMBING i )y-\J\,
4' /p. 'S f CITY OF ATLANTIC BEACH
10
*. , - ,. 800 SEMINOLE ROAD
JATLANTIC BEACH, FL 32233
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INSPECTION PHONE LINE 247-5814
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PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-1288
Job Type: PLUMBING ONLY
Description: PLUMBING - WATER HEATER
Estimated Value:
Issue Date: 6/6/2016
Expiration Date: 12/3/2016
PROPERTY ADDRESS:
Address: 440 GARDEN LN
RE Number: 172020-5214
PROPERTY OWNER:
Name: HASSI, EDWARD D
Address: 81 -83 GRANT ST APT 7
GENERAL CONTRACTOR INFORMATION:
Name: WATSON PLUMBING
Address: 4456 SUNBEAM RD APT 200 MILES CARLYON
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: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND 771E FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-5845 1 (p-PLgG _ .ase)Q
JOB ADDRESS: 44-o Gl c \•A PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
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:
o Sewer Replacement Back Flow Preventer 0 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
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 (.6A\St).N 'YFElrfli IANI AO,(til &-T Phone Number g 53 -34.27,(
Plumbing Company L()P1*Spr.L `Q 10tA / Ca Office Phone 737 -4,33 7 Fax R99.6 eV
Co. Address: 44.56 5c)&005.k1( • City ace.A,SbAtta,t,it State ei Zip,33-a57
License Holder(Print): .EcLoAEtA,5
6 5c) S ification/Registration# CSG 0S76�4
Notarized Signature of License Holder L V /V if
Artr
Sworn and subscribed before me th'. • y of 20 16,
KEUYBAUM
* * MY COMMISSION FF 0971$6 Signature of Notary Public /
EXPIRES:March 2,2018
AA.4rfBowledNuBudgltNotary s/rrkes