967 CAMELIA ST PLBG PERMIT " 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-1291
Job Type: PLUMBING ONLY
Description: PLUMBING - 17 FIXTURES
Estimated Value:
Issue Date: 6/7/2016
Expiration Date: 12/4/2016
PROPERTY ADDRESS:
Address: 967 CAMELIA ST
RE Number: 170967-0000
PROPERTY OWNER:
Name: BENNETT, KEVIN
Address: 4429 JIGGERMAST AVE
GENERAL CONTRACTOR INFORMATION:
Name: ASHLEY PLUMBING CO INC
Address: 542435 US Hwy 1
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $119.00
Trade Permit Base Fee $55.00
Total Payments: $178.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
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PERMIT RECEIPT
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PERMIT DESCRIPTION: PLUMBING -17 FIXTURES
PERMIT NUMBER: 16-PLBG-1291 pp,10
ADDRESS:967 CAMELIA ST 10 012016
OWNER: CIT(OF AAnNTICBEACN
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DATE ISSUED:
FEES DUE:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $119.00 - CITY OF ATLANTIC BEACH
800 SEKNOLE RD
ATLANTIC BEAC,R 32233
Trade Permit Base Fee $55.00 06,07(2016 12:37:57
CREDIT CARD
NSA SALE
Totals: $178.00 CARD u XVMXX=3811
IMNACE 0005
SEQ N: 0003
Batch;: 000332
"Val WE 05089G
BPM xd: Maual
Mode: Onliu
Tac Arrant: $0.00
Cad Cade: M
SALE AMOUNT $1100
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CUSTOMER COPY
JUN-07-2016 04:04 From: To:19042475845 Pase:213
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-58,2(6 Fax (904)247-5845 I (0 —P L 3 C, Zc
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OB ADDRESS:_ 9l� 7 ��,� 5l r -f PERMIT/1
IEW OR REPLACEMENT INSTALLATION: Project Value$
TPPEoFFtxTvRE QTY TYPE or FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer `T- Shower
Dishwasher Shower Pan
Drinking Fountain Stop Sink
Floor Drain Three Compartment Sink —T
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink _ Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater ,J_
Other Fixtures m Water Treating Syste
E-PIPE:
TYPE OF FIXTURE QTY . TYPE oFFIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain ,i 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
IISCELLANEOUS:
Sewer Replacement 17 Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 seta of plans)
Lawn Sprinkler System-Number of Heads ❑ Well
'SIRWD Well Completion Form. Complete fib be submitted to thing Department for final inspection.*"
Other
Emit bmnmes void if work does not Commence within a Six month period or work is suspended or abandoned for six months.1 hereby certify Not 1 have read
S application and know the same W be[me and correct All provisions of laws and ordinances governing this work will be complied with whether specified
not The permit docs not give authority to violate the provisions of any other note or local law regulation construction or the performance ofconstmetion.
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umbing Company H W'l>b /Yw/�i�� 3'J.r Office Phoncai-S32ZV Fax L 3gY DSSS�
>. Address: d L& AA42 City ('0 J!All a'1 State Zip : "2�01/�01/
cense Holder(Print): 'I AA gki S,�te Certification/Registration# rf- l7 S'J.S3U�
rtarizedSignature ofLicense Holder
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