581 CRUISER LN - PLUMBING Jn
CITY OF ATLANTIC BEACH
' . SJ
` - _ ,) 800 SEMINOLE ROAD
\J — „r 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-1700
Job Type: PLUMBING ONLY
Description: 1 Water Heater
Estimated Value: $500.00
Issue Date: 7/28/2016
Expiration Date: 1/24/2017
PROPERTY ADDRESS:
Address: 581 CRUISER LN
RE Number: 170703-0334
PROPERTY OWNER:
Name: LISTON, COLIN & FRICK J, *
Address: 186 ROSCOE BLVD
GENERAL CONTRACTOR INFORMATION:
Name: POLAR PLUMBING
Address: P 0 BOX 2004 MICHAEL RICHARD NIQETTE
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: $66.00
li
PERMIT IS APPROVED ONLY IN ACCORDANCE W I"III ALL CITY OF ATLANTIC BEACH ORDINANCES AND TIIE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach.FL 32233
Ph(904)247-5826/ �•�Fax(904)p247-58455
JOB ADDRESS: SSL Lcv ���
;Nstir 1 \. :L D ICV1 \L 3fl ERMIT# I (o—RE& - IVO
NEW OR REPLACEMENT INSTALLATION: Project Value$ SOO.60
TYPE OF FIXTURE QTY TYPE OF FIXTURE OT1
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:
Sewer Replacement 77.1 Back Flow Preventer 7, Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
Lawn Sprinkler System-Number of Heads Well **
**SIRWD 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 he 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 t; i r 5 U.c C Phone Number QOLI' tie
Plumbing Company QOffice Phone y114.111-SCA'O Fax SOH-llkl-
Co.Address: f RX 2_ ,` •
C y �a�__...` . State F L Zip 3ZOSO
I N
License Holder(Print):
Ava.e.� ►(�ta,�, Z it- :'� ation/Registration# CFCliZ$Z(0(o
Notarized Signature of License Holder / r, �,
Before me this v of !fi, 20 A� /
i,;;m".'�... Signature of NotarPuhl �. � A A
.•0 4c. SARAH ANNE ROBERTSON ��'�
xMY COMMISSION#FF094516
''•.,Zp.nd;� EXPIRES February 20.2018
0171;8 0153 FlondallolaryService.com
`s " ATLANTIC BEACH
' . s PERMIT RECEIPT
�(' 1319 '
PERMIT DESCRIPTION: 1 Water Heater PIN")
PERMIT NUMBER: 16-PLBG-17002O't
.0- 28
11 ADDRESS: 581 CRUISER LNT�p,NTCBENG"
or(OFA
OWNER: J\Qi161)1W
DATE ISSUED:
FEES DUE:
State PLMG DBPR Surcharge $2.00 I
State PLMG DCA Surcharge $2.00 CITY OF ATLANTIC BEACH
800 SEMINOLE RD
ATLANTIC BEAC,FL 32233
Plumbing Fixtures $7.00 07128,2016 10:09:43
CREDIT CARD
Trade Permit Base Fee $55.00 VISA SALE
CARD XXXXXX O(XXXX2775
INVOICE 0001
SEQ#: 0001
Totals: $66.00 Batch#: 000367
Approval Code: 383681
Entry Method: Manual
CITY OF ATLANTIC BEACH Mode: Online
800 SEMINOLE RD Tax Amount: $0.00
ATLANTIC BEAC,FL 32233 Card Code: M
07128.2016 10:11:32
CREDIT CARD SALE AMOUNT $25,04
VISA SALE AMOUNT DUE $40,96
CARD a3 XXXXXXXXXXXX0727
INVOICE 0002
SEQ k: 0002
111 Batch it:
000367 BALANCE INFORMATION
Approval Code:
412567 NS REQUESTED AMOUNT: $66.00
Entry Method: Manual
Mode: Online CUSTOMER COPY
Tax Amount: $0.00
iii Card Code: M
SALE AMOUNT $40,96
CUSTOMER COPY