580 TIMBER BRIDGE LN 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
306 INFORMATION:
Job ID: 16-PLBG-1320
Job Type: PLUMBING ONLY
Description: PLUMBING -22 FIXTURES
Estimated Value:
Issue Date: 6/912016
Expiration Date: 12/612016
PROPERTY ADDRESS:
Address: 580 TIMBER BRIDGE LN
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: DARLEYS PLUMBING INC.
Address: 4472PHILLIPSHWY CA CARL LESLIE DARLEY
Phone:
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $154.00
Trade Permit Base Fee $55.00
Total Payments: $213.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax (904)247-5845 "�2-PL6� -1
JOB ADDRESS: 5-60 7y�x:-R- b�� PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPEoFFixTuRE Qry TYPE OF FixTuRE QTY
Bathtub 2 Septic Tank& Pit
Clothes Washer I Shower Z
Dishwasher I Shower Palo
Drinking Fountain Slop Sink
Fluor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray Water Connected Appliances
Larvalany Water Heater
Other Fixtures Water Treating System
RE-PIPE: TYPE OF FixTuRE TQff -v/ TYPEOFFIxTURE QT1
Bathtub Septic Tank& Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink E-G-E 0 IV F.
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal --iw- 8 2016
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Applian
Lavalog Water Heater
Other Features Water Treating System
MISCELLANEOUS:
Ei Sewer Replacement [I Back Flow Preventer 11 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
o Lawre Sprinkler System-Number of Heads El Well
**SJRWD Well Completion Form. Completed form wo be submitted to the Building Department for final inspection."
Ei Other
Permit becomes void ifwork does not commumce within a six month period or work is suspended or abandoned for six months.I hereby certify,that I have mad
this application and know the same to be me and correct All previsions of laws and ordinances governing;this work will be complied with whether specified
or mt. The permit does not give authority to violate the provisions of my other slate or local law regulation constructim or the performance of construction.
Property 0wrters Name —FDL� 3,g*� Phone Number
PlumbingCompany. &AZi�ll 7'Dc OfficePhone '727-/reY Fax-2 148 S
Co. Address: r/7Z Pnw-fz�f I-1w city 7�4x State Zip ??L 0-1
License Holder(Print): ClliLAL 4)AC I- State Certification/Registration#
Notarized Signqtalregf�License Holder 0 , A') aO,,
I I Sworn and subscribed before mWh,, Y- day of J�ji^,V 201/,
III NI MIHL
";N
Al e.Soall.f Florida
My Comm.Upires Aug 29,2016 E Signature of Notary Public
57'
Commiss,on#EE�829576
Naia�Bowed Through National ry All.
CM 11 ATLANTIC 11111
BOO SEWLE RD
ATLANTIC BEAC,F.32233
06,090016 D9:03:20
CREDIT CARD
VISA SALE
Cud 4 W000=1437
SEQ t I
w#: 146
INVOICE I
Approval Code: 09608G
Erty rdw: mnal
fte: onlive
Tax Armirt: 00
Card Code: m
SALE AMOUNT $213m
COSTOMER COPY
CITY OF ATLANTIC BEACH
ROD SEMINOLE ROAD
ATLANTIC BEACH, FL 22233
PHONE (904) 247-5855
Cashier Id: atlbcld\atibbja
Receipt Date: 6191201fi 9:03:57 AM
Receipt Number: OS-70DG1
Job ID: 16-KBC-1320 - PLUMBING - Z2 FIXTUR
ES PDBPR - State PLMG DDPR Surcharge $2.0
0
Job ID: 16-PLBG-1320 - PLUMBING - 22 FIXTUR
ES PWA - State PLMG DCA Surcharge $2.00
Job ID: 16rPLBG-1320 - PLUMBING - 22 FIXTUR
ES PLI - Plumbing Fixturre $154.00
Job ID: 16-PLBG-1320 - PLUMBING - 22 FIXTUR
ES TP - Trade Perm it Base Fee $55.00
Amount Due: $213.00
Tender Information: Cash $213.00
Tender Type: CC
Terxier Amnurt: $213.00
Ch��g Due: $0.00