1871 ATLANTIC BEACH DR - PLUMBING y•
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CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-1115
Job Type: PLUMBING ONLY
Description: PLUMBING - NEW SERVICE ,20 FIXTURES
Estimated Value: $5,000.00
Issue Date: 5/13/2016
Expiration Date: 11/9/2016
PROPERTY ADDRESS:
Address: 1871 ATLANTIC BEACH DR
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 $140.00
Trade Permit Base Fee $55.00
Total Payments: $199.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845 1 G -P La , _ [ t 1.5
JOB ADDRESS: ree) I ATt.4...-rte.. 3/Ar'14 Q'` PERMIT# /� "S/6<-2/
NEW OR REPLACEMENT INSTALLATION: Project Value$ 511106'
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub (( Septic Tank& Pit
Clothes Washer I Shower —
Dishwasher / Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs ____t_ Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray I Water Connected Appliances
LavatoryWater Heater /
Other Fixtures aa
Treating System
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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 ❑ Back Flow Preventer L Grease Interceptor (Trap) gallons(Requires 3 sets of plans)
cl Lawn Sprinkler System-Number of Heads Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
CJ 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 autthority to violate the ocavisions of any other state or local law regulation construction or the performance of construction.
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Property Owners N me �°'-C_ I7ti o_3 Phone Number
Plumbing Company�� .Ail , '`l h hY‘i:)l 3Office Phone-ol-4-I tikti FaxatiVICS—
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Co. Address: i,1 as . CityIctebaNAkg_ State Zip
License Holder(Print): • A 1.1!.. 11,A. __._..Ab, ______Ce Certifi ation/Registration # ..cra
v i'Vitiarizgd Sign
a_ _ fture o License Holder ' c '
' .,P,ir a q,, JOANNE MEHL
I Sworn and subscribed before e this /0 day of 20 /a
rte.�.� Notary Public-State of Florida �
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i:„.1. !,i . •;My Comm.Expires Aug9.2016
iii F g r Signature of Notary Public ,`t e III��� 0• Commission#EE 829576 --
Bonded Through National Notary Assn. 0