1048 LITTLE CYPRESS KEY PLUMBING PERMIT 0rL,IfJ ,
4' -4440,,,,, i, CITY OF ATLANTIC BEACH
l 800 SEMINOLE ROAD
Alli r�I ATLANTIC 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-1478
Job Type: PLUMBING ONLY
Description: PLUMBING -WATER HEATER
Estimated Value:
Issue Date: 6/28/2016
Expiration Date: 12/25/2016
PROPERTY ADDRESS:
Address: 1048 LITTLE CYPRESS KEY
RE Number: 172027-5816
PROPERTY OWNER:
Name: REVEL, EDWARD & PATRICIA, *
Address: 1048 LITTLE CYPRESS KEY
GENERAL CONTRACTOR INFORMATION:
Name: DAVID GRAY PLUMBING INC.
Address: 6491 S POWERS AVE QA DAVID FRED GRAY
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: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDI\A\CFS AND 171E FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION •
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904) 247-5845 16 - P L('_ 14-7 ,E ),
.TOB ADDRESS:I d`1 J L-I-I. L Ctipas3 ! PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
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
Hose Bibs
Kitchen Sink
Laundry Tray
Lavatory
Toilet
Urinal
Vacuum Breakers
Water Connected Appliances
Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement 0 Back Flow Preventer 0 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
o Lawn Sprinkler System-Number of Heads 0 Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
o 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_ptoviolatethe provisions of any other state or local law regulation construction or the performanceyof construction.
Property Owners Name got flttitfo
t Phone Number`101 "a tiq-501P/
Plumbing Company l d Cyal PI l.Ai-i-b rC , 14, . Office Phone OL'7 "72) I Fax °H4'72)4-5'i2s
Co. Address: (04C11 t"0t (11,1-t City,SiGic 5 dr'''t I Le State hl. Zip 322i(
ti
License Holder(Print): t D GRAV State Certification/Registration# CIC 0 27.5d'?P
Notarized Signature of License Holder :�ep
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My Commission FF 180386 o�n Expires 01/04/2019