850 SEMINOLE RD - PLUMBING ��\Ji t
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�" ' : I,s\ CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
10
. ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-1856
Job Type: PLUMBING ONLY
Description: PLUMBING - 44 FIXTURES
Estimated Value: $80,000.00
Issue Date: 8/16/2016
Expiration Date: 2/12/2017
PROPERTY ADDRESS:
Address: 850 SEMINOLE RD
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: CAMPBELL PLUMBING
Address: 11482 -01 CO W COLUMBIA PARK DR QA KEITH MICAHEL
CAMPBELL
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $308.00
Trade Permit Base Fee $55.00
Total Payments: $367.00
PERMIT' IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
CTUE)AUO 18 2018 7:58/ST. 7:57/No.8308405482 P 2
FROM
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH 1 (a- PL-8 , -/g5 ).
800 Seminole Rd Atlantic Beach, FL 32233 i'1‘43 �� fi
Ph(904) 247-5826 Fax (904) 247-5845
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lOB ADDRESS: 850 S c rn 1 N 01C /hoc.a PERMIT#
vEW OR REPLACEMENT INSTALLATION: Project Value$ 8O poo %-
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit _
Clothes Washer Shower
Dishwasher Shower Pan Ps
Drinking Fountain 1 Slop Sink
Floor Drain i I Three Compartment Sink
Floor Sink Toilet
Hose Bibs 5 Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray Water Connected Appliances 3
Lavatory i U Water Heater
Other Fixtures a ,J Water Treating System
2E-PIPE: t'k1L�y
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
VIISCELLANEOUS:
Sewer Replacement (] Back Flow Preventer 0 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
3 Lawn Sprinkler System-Number of Heads D Well **
°* SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
$Other (a.l 04-‘,,t, Piy-1�.,, I. 4bl.,t (IN rkr4.,4}t. a (I \ Mhp S1n:l�
'emit 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
his 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
)r 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.
?roperty Owners Name 0,4,3 of A 414,..},( (3c�,1,, Phone Number
90t-►' 904-
?lumbing Company Oct n,p611 ni W55 C04\o.t.A-cr S f - Office Phone 3&"7- et 9 9 L Fax 3 E?-5066
-o. Address: 91 a.Fs FlorA, ),Ph,.,,, {11„4 w.. City .14c_t-so. ..,llr State (C. Zip 3 D3S')
License Holder(Print): &e,-\\ in. Cct w.* e.-41 State Certification/Registration# C c'C.14 a(I I"1
Votarized Signature of License Holder
• Sworn and subscribed before me is 16 da of > st 20 1L
8i:PARA APE Ct[,!PBEII-COSiANZO ' //�� /'i
'r i mssien 1;FF 139194 • Signature of Notary Public . 1. (�cr,
W` expires August 22,2018
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