2359 SEMINOLE RD - PLUMBING 01A41:4.1
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CITY OF ATLANTIC BEACH
#14 s) 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-1536
Job Type: PLUMBING ONLY
Description: PLUMBING - SEWER TAP
Estimated Value:
Issue Date: 7/7/2016
Expiration Date: 1/3/2017
PROPERTY ADDRESS:
Address: 2359 SEMINOLE RD
RE Number: 168349-0000
PROPERTY OWNER:
Name: JACOBSON, SAMUEL S
Address: 2359 SEMINOLE RD
GENERAL CONTRACTOR INFORMATION:
Name: METRO ROOTER
Address: 8892 NORMANDY BLVD QA THOMAS ALLEN MCLAUGHLIN
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: $66.00
PERMIT' IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION j . P t- u
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845 J �_PL- _15 3
JOB ADDRESS: 02 3 0 5614/42V-e. A. PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank& Pit
Clothes Washer Shower
Dishwasher Shower Pan
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:
A Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons(Requires 3 sets of plans)
o Lawn Sprinkler System-Number of Heads ❑ Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
o 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 V'l)" `441)8.9A1 Phone Number 2` ?,,-- 6/ 47
Plumbing Companyne7/xa--,e6°re-'Q Office Phone '7j/71) FaxI 1f/840
Co. Address: 3?2 /4/4 14/AWL 7 /,� vi. City JAS State PG Zip,3�?'Ll
License Holder(Print): !d' /`'5 L 4 # Li State Certification/Registration#CFC 4$Z?o 2.
Notarized Signature of License Holder 114,3
MARY HOWMAN Sworn . • subscribed before this0� ( day of U�� 20 1,L
4wus Commission#FF 026041
Signature of Notary Public / 't ��--
Expires October 11,2017
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