601 COASTAL OAK LN - PLUMBING le r4fr
o' / `` CITY OF ATLANTIC BEACH
a 'ii-".._ f 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-1647
Job Type: PLUMBING ONLY
Description: install 2 tubs, washer, dishwasher, 2 hose bibs, sink, laundry tray.
5 lavatories, 2 showers, 4 toilets, 2 water connected appliances, wh, trtmt sys.
Estimated Value:
Issue Date: 7/21/2016
Expiration Date: 1/17/2017
PROPERTY ADDRESS:
Address: 601 COASTAL OAK LN
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: DARLEYS PLUMBING INC.
Address: 4472 PHILLIPS HWY QA CARL LESLIE DARLEY
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $161.00
Trade Permit Base Fee $55.00
Total Payments: $220.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND 771E FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: 601 (-04.17A-C. 04/c- I/fr PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Z Septic Tank& Pit
Clothes Washer I Shower �_
Dishwasher I Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet Y
Hose Bibs _2_— Urinal
Kitchen Sink ____L___ Vacuum Breakers
Laundry Tray r _ Water Connected Appliances L
Lavatory _,5__. Water Heater ____L_
Other Fixtures Water Treating System ___L_
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:
❑ Sewer Replacement LI 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.**
ii 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 (oI, te> Phone Number
Plumbing Company D)C-.cE.?( 4t4 .w3;,.e..- 2-Jc. Office Phone 717 /YBY Fax 7Z7 /tier-
Co.
9&1Co. Address: y y 72 If{ LL-CIT IfiAre City J Aye State wt. Zip T u 0>
(
License Holder(Print): AA-L C. i/kt State Certification/Registration# CF 0..3`616 t-
lder eft,-‘., L„,,/a___4,--
..1"",T, JOANNE MEHL
£' —.1.`n; Notary Public-State of Florida Sworn and subscribed before e this Q-1 day of c.S�1,( 20
•« , .•i My Comm.Expires Aug 29.2C16 1
'-::,,,:4=.14-`,:7,= Commission#EE 829576Signature of Notary Public
Bonded Through National Notary Assn.