1889 ATLANTIC BEACH DR - PLUMBING s, CITY OF ATLANTIC BEACH
y 1J 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-1685
Job Type: PLUMBING ONLY
Description: install 2 tubs, washer, dw, 2 hose bibs, sink, 2 laundry trays, 5
lavatories, 2 shower, shower pan, 4 toilets, heater, water trmt system, 2 we applian
Estimated Value:
Issue Date: 7/27/2016
Expiration Date: 1/23/2017
PROPERTY ADDRESS:
Address: 1889 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 $175.00
Trade Permit Base Fee $55.00
Total Payments: $234.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AM) 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 t{p - PI—( - WIG-
JOB
' 'JOB ADDRESS: ) g8�1 /T 7G4.-1.7Z-c- /?4 04- PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 2 Septic Tank&Pit Z
Clothes Washer I Shower
Dishwasher ___L— Shower Pan _A_
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
—2- y
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink __I__ Vacuum Breakers
Laundry Tray L Water Connected Appliances Z
Lavatory S Water Heater I
Other Fixtures Water Treating System ___L—.
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:
E Sewer Replacement ❑ Back Flow Preventer E Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
n Lawn Sprinkler System-Number of Heads n 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 --re,(...,_
Phone Number
Plumbing Company O A-t ,,`-^,c R.'-..^^`S' 'c. -L'�
Office Phone -7Z-7-IY13y Fax `7L7/yd5-
Cit T�'�` State (-71_ Zip In 0 7
Co. Address: Y' 7Z Pft- OS ii---,-/ City
License Holder(Print): CALL L- e State Certification/Registration# d- o s 7°Z
Signature ofLicense Holder (n�
Notarized � ."��� __________
Sworn and subscribed before me his .., day of �`11 20 1 Cly
JOANNE MEHL / ��� 1
"YSignature of Notary Public
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— �.4• Notary Public es Aug01 Florida
.1 •_My Comm. •Expires A 29,2t'16
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1,‘P, ;P.:6:::: Commission#EE 829576
%°;,:;"� Bonded Through National Notary Assn.