1700 PARK TERR E - PLUMBING 0
` rrtt , s J CITY OF ATLANTIC BEACH
!!i` si 800 SEMINOLE ROAD
JATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
itvJ;319'�
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-1132
Job Type: PLUMBING ONLY
Description: PLUMBING - REPACE SEWER
Estimated Value: $4,200.00
Issue Date: 5/17/2016
Expiration Date: 11/13/2016
PROPERTY ADDRESS:
Address: 1700 E PARK TER
RE Number: 172020-0318
PROPERTY OWNER:
Name: POPPELL, RONEL J
Address: 1700 PARK TER
GENERAL CONTRACTOR INFORMATION:
Name: PIPE WORKS LLC
Address: 8340 Thoenton RD
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: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE wiTil ALL ('III' OF ATI.AN"17C BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845 1 6 -Pse:- C ( 3 Z
JOB ADDRESS: I n 00 Poi cC K — ¶e r r G r{ GQ 5T PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$ '�7'./,'`fr z 00 , 00
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
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
SCELLANEOUS:
Sewer Replacement ❑ Back Flow Preventer 0 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 fl u►r c' \ no\ Phone Number GSI•q ice` - C
Plumbing Company 19te{ W0-110 LLC Office Phone qv; O Fax 20 os-Re,
Co. Address: X3'4 ^ 1vrit4rlrh CI- City 351k State F( Zip ,3222)
License Holder(Print): J OSfph 67,1-6 State Certification/Registration# C'1fC I g2S")k2_
Notari ed Sigt2Aturp mf__ . er
.•fg�;y;�. '� G°:��'�,ESPERGER Y~ I 1.'\,1\,
n f'
,., ,- MY i;' ,.�.,:,_;-'1 it a 924951 4fore e thisday of ! V 2
g.7�- EXPI S:. �tctsr 6,2019 >�
nature of Notary Public 01 v