1690 ATLANTIC BEACH DR - PLUMBING y\J\,
c,' . • �s, CITY OF ATLANTIC BEACH
J 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-1779
Job Type: PLUMBING ONLY
Description: PLUMBING - 28 FIXTURES
Estimated Value:
Issue Date: 8/5/2016
Expiration Date: 2/1/2017
PROPERTY ADDRESS:
Address: 1690 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 $196.00
Trade Permit Base Fee $55.00
Total Payments: $255.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845 I ( -PL EG -1779
JOB ADDRESS: / 650 A7 -4';K /3"-t,-.4 A PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 3 Septic Tank& Pit
Clothes Washer I Shower ___2—
Dishwasher
Dishwasher / Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet —
Hose Bibs _ Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray _J_ Water Connected Appliances 2-
Lavatory _Z Water Heater
Other Fixtures Water Treating System _ _
RE-PIPE:
-1Y
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 ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
Lawn Sprinkler System-Number of Heads 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 1 To t-i... (3(b) Ti"- Phone Number
Plumbing Company #42 Iscr.".1•( ac//A+3 4 7.! Office Phone 7t/ -I Y8'I Fax -72-1 /yes--
Co.
8SCo. Address: (p/7 L P ErLA.V$ 01-viii City ,JAx State/--(- Zip 3Lt
License Holder(Print): CA/-c L D -may State Certification/Registration# CFC OS-4 got
Notarized Signature of License Holder -Ci•, C_ �0....G
Sworn and subscribed before �� e this S day ofS 20`Sp
0,,:;,:!("1!;;,, JOANNE MEHL Signature of Notary Public le
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Notary Public-State of Florida
•: r* . •E My Comm.Expires Aug 29,2016 6 'IL
.-v=`p Commission#EE 829576
4 •'!4on1/2;'s 8nndnd Thrnunh Natinnal Nntary Assn 0