1750 SELVA MARINA DR - PLUMBING �:aVVr
` ``ss, CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
D 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-1849
Job Type: PLUMBING ONLY
Description: replacing tub, dishwasher, sink. laundry tray, lavatory, ice maker,
toilet
Estimated Value: $1,450.00
Issue Date: 8/15/2016
Expiration Date: 2/11/2017
PROPERTY ADDRESS:
Address: 1750 SELVA MARINA DR
RE Number: 172008-0000
PROPERTY OWNER:
Name: ONDREJICKA. JOHN A
Address: 1750 SELVA MARINA DR
GENERAL CONTRACTOR INFORMATION:
Name: A TO Z CONTRACTING AND PLUMB
Address: 406 HAMLET RD BRETT ALAN THOMAS
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $42.00
Work W/O Permit Plumbing $55.00
Trade Permit Base Fee $55.00
Total Payments: $156.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233 16— f t_€-1— 110-11
Ph (904) 247-5 826Fax (904) 247-5845
•JOB ADDRESS: SrC 5A\ 1 fl'1�( r l A .0" PERMIT#/� �A_� 33
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NEW OR REPLACEMENT INSTALLATION: Project Value$ I 466 `—
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 1 Septic Tank&Pit
Clothes Washer Shower
Dishwasher 1-. Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet _1___
Hose Bibs Urinal
Kitchen Sink 1 Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures f Water Treating System
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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 ❑ Back Flow Preventer 0 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
o Lawn Sprinkler System-Number of Heads 0 Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
O 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 ofany other state or local law regulation construction or the performance of construction.
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Property Owners Name I - -J c / Phone Number
Plumbing Company P--\-O Z. COn/T/O-G. ,I -a- Uvhb Qffice Phone 3900907 Fax
Co. Address: 7i (evl t ?.„A._-c
City S {9,< Stated ( Zip 3.c
License Holder(Print): f * p(4t.lA S State Certification/Registration it c (1 *.).RAZ
Notarized Signature of License Holder \ r
,;;::y. TONI GINDLESPERGE- }
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MY COMMISSION It FF 924951 I.efore me this 1 `-� day of�l iv �� 20{�
,.:�� EXPIRES:October 6,2019
•','i $' BcndedThruNctarYPcb�Underwriters ,gnature of Notary Public _ • _.
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