1793 ATLANTIC BEACH DR - PLUMBING 41,J.,v:riel
g ,41 °S f CITY OF ATLANTIC BEACH
r A. s) 800 SEMINOLE ROAD
j 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-1778
Job Type: PLUMBING ONLY
Description: PLUMBING - 22 FIXTURES
Estimated Value:
Issue Date: 8/5/2016
Expiration Date: 2/1/2017
PROPERTY ADDRESS:
Address: 1793 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 $154.00
Trade Permit Base Fee $55.00
Total Payments: $213.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH AI.I. CITY OF ATLANTIC BEACH ORDINANCES AND TIIE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845 1G PLbG 17 78
JOB ADDRESS: 'i43 ATL4V•XTA- &AC14 A" PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 2. Septic Tank& Pit
Clothes Washer __i-__ Shower
Dishwasher I Shower Pan _-1---
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet —7----
Hose Bibs 1• Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray i Water Connected Appliances 2,
Lavatory 5'. Water Heater t
Other Fixtures Water Treating System I
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 o Back Flow Preventer n Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
I Lawn Sprinkler System-Number of Heads ❑ Well **
** SJR WD 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 1 O e.t. 34.05 Phone Number
Plumbing Company OA.t.rf:...1's / ..,,H.?2;,./4 ,ZJc Office Phone 72-?-/Y?t/ Fax 72,-I rgS
Co. Address: L(Y 7 2 MIA'-c-PS N./y City State ---t- Zip 12-1-D 7
License Holder(Print): C�- C.. a State Certification/Registration# CFC of6 70Z
g
Notarized Signature of License Holder O -43 -C2' de
Sworn and subscribed before ' e this - day of (ii, 20 1(
JOANNE MEHL
o•P " Si nature of NotaryPublic /milkW WWII
;_•lie.c.', NotaryPublic State of Florida g
•; a, :•E My Comm.Expires Aug 29.2016
'ss'��,Pc. Commission#EE 829576
-'"%OP \"� Bonded Through National Notary Assn. N.