670 SHERRY DR - PLUMBING �1 \ 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-654
Job Type: PLUMBING ONLY
Description: PLUMBING - ONE SHOWER PAN
Estimated Value:
Issue Date: 3/23/2016
Expiration Date: 9/19/2016
PROPERTY ADDRESS:
Address: 670 SHERRY DR
RE Number: 170398-0000
PROPERTY OWNER:
Name: GORDON, JOHN W
Address: 670 SHERRY DR
GENERAL CONTRACTOR INFORMATION:
Name: LARRY TEAGUE & SONS PLUMBING
Address: 203 OCEANFRONT QA ARNOLD GEORGE BENNETT
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.
,:, ._....t,,,,-J,.,j � ATLANTIC BEACH
s
f
PERMIT RECEIPT
PERMIT DESCRIPTION: PLUMBING - ONE SHOWER PAN
PERMIT NUMBER: 16-PLBG-654
ADDRESS: 670 SHERRY DR
OWNER:
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: $66.00
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax (904)247-5845 1(0- PLE _ 654-
JOB ADDRESS: Co 7C) ,cheirti ihU ye PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan 1
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 Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
D Sewer Replacement 0 Back Flow Preventer 0 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
C Lawn Sprinkler System-Number of Heads o Well **
**SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
D 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 PA CK- Gl y Phone Number / y79-59(1-2
Plumbing Company 1 i E-A-Gag 1j-- jNS Office Phone/0:1.2.:76-1a9 Fax96k.,244.g2-4.44
Co. Address: 3 De- °' CityState )=1 Zip 3 2244License Holder(Print): are#1J61-O E State Certification/Registration# 0,9'C. a.iS l9
Notarized Signature of License Holder eAr J t...0
MELANIE A.DARLINGTON• worn and subscribed before me this /?A day of Oil est .a 2016
r� '= � ��r tis, 'ignature of Notary Public Zia/La d..._ li ,IpisciL,
"• 2p16
ExPIR
(Rost 39e.oi53
I.'d 69Z9-617Z-1706 suos pue en6eel/Wei