715 ATLANTIC BLVD - PLUMBING \S, CITY OF ATLANTIC BEACH
lJ 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-1812
Job Type: PLUMBING ONLY
Description: PLUMBING - 6 FIXTURES
Estimated Value:
Issue Date: 8/9/2016
Expiration Date: 2/5/2017
PROPERTY ADDRESS:
Address: 715 ATLANTIC BLVD
RE Number: 177541-0000
PROPERTY OWNER:
Name: PREM AND POOJA LLC
Address: 7545 CENTURION PKWY SUITE 204
GENERAL CONTRACTOR INFORMATION:
Name: KELLEYS PLUMBING CONTRACTING
Address: 3866 VALENCIA RD MICHAEL RYAN KELLEY
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $42.00
Trade Permit Base Fee $55.00
Total Payments: $101.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax (904)247-5845 1 C - P L-6G -- I g i L,
JOB ADDRESS: 7( A-I N I i<' SL✓T2 R" -4,,,7�b }? 371 S) PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
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
LaundryTrayWater Connected Appliances 1/
Lavatory _ __ Water Heater
Other Fixtures —' 4` Water Treating System I
RE-PIPE: /rn
Q
TYPE OF FIXTURE TY LP 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 0 Back Flow Preventer 0 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads 0 Well **
**SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ Other r,{,.—-1-,– 1e L.
' ATL-- .,�Ir l 61-- Ejr$T' 5,7-- I-A. Live //.1),•- c,A--,eit 6--,4 1.... e4,Ar '�hL ,`a `2,A-6a-
I-/ .S) .J'r4/� t A--^.-,✓/ /N�/a-e z- LA> C4 - , ) NvY\ c.0,„,f/Y//rk L f a,_,;7,,-,4--,..-7
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 a ority to violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name (2� Eo O d. PO. + i 0 C- Phone Number
Plumbing Company KEu e/S--Pc-4i,,G C1 c)5V - I,c- Office Phone 3a 2 �� Fax
Co. Address: 3Ff CPU V'4 ''C l/- City NcicSo.`"t_i, ;" State FL Zip 32Z
License Holder(Print): M I 6,14-40- 16/4-,1 I U1 State Certification/Registration# 2Y 1/oto75 o j
Notarized Signature of License Holder A
efore me this da ►, �!► 20 f'0
,r-'� Ttar Public e 1
, ,: = MY CO?IMISS!ON#FF 924951 ignature of Notary
vx.�,a EXPIRES:OvtOb r 6,2019
ARf„t1 Bonded Thru Notary Puai.Underwriters