970 ORCHID ST PLUMBING PERMIT CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
J
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-1326
Job Type: PLUMBING ONLY
Description: PLUMBING -WATER HEATER
Estimated Value: $675.00
Issue Date: 6/10/2016
Expiration Date• 12/7/2016
PROPERTY ADDRESS:
Address: 970 ORCHID ST
RE Number: 170947-0110
PROPERTY OWNER:
Name: SAPIA, PAUL CHARLES
Address: 808 BONAIRE CIR
GENERAL CONTRACTOR INFORMATION:
Name: BROWARD FACTORY SERVICES BFS
Address: 2071 EMERSON ST JERRY LEROY BRIGHTWELL
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.
ATLANTIC BEACH
= PERMIT RECEIPT
PERMIT DESCRIPTION: PLUMBING -WATER HEATER
PERMIT NUMBER: 16-PLBG-1326 PAID
ADDRESS: 970 ORCHID ST JUN 10 2016
OWNER: CITY OF ATLANTIC BEACH
DATE ISSUED:
FEES DUE:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $7.00
Trade Permit Base Fee $55.00
Totals: $66.00
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: q-w r)r&1 A S+ PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value $ 13'_(_9P
TYPE OF F/XTURE QTY TYPE OF F/XTURE 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 F/XTURE QTY TYPE OF F/XTURE 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 any other state or local law regulation construction or the performance of construction.
Property Owners Name P�e �a tQ Phone Number R b C1-3 u-(0 i)
Plumbing Company -fO W oarA -r a G+ory 5.e cc;i 4-9- Office Phone g0Lf 6S7f-s Fax46q-3 t
Co. Address: X71 C ers h sf- *(v City Zi c K5om of 11 e_ State__e_Zip 3 �
License Holder (Print): Le ion# C FCO 5tv`61 7
Notarized Signature of License Holder
EM
�/ day of.J �iL.�, 20MELLE K CARL$ orn nd sub ribe e me this COMMISSION p FFggg34PIRES February 1�,Z020 gnature of No ary Public
N
oaa