292 16th St PLBG permit ®r ;
CITY OF ATLANTIC BEACH
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-2065
Job Type: PLUMBING ONLY
Description: PLUMBING - 3 FIXTURES
Estimated Value: $2,200.00
Issue Date: 9/14/2016
Expiration Date: 3/13/2017
PROPERTY ADDRESS:
Address: 292 16TH ST
RE Number: 170385-0000
PROPERTY OWNER:
Name: HANDLEY, CHARLES & DIANE, `
Address: 292 16TH ST
GENERAL CONTRACTOR INFORMATION:
Name: Clay County Master Plumbing LLC
James Kelvin Pelky,CFC 058079
Address: 449 Arthur Moore Dr Green COVE
Phone: 904-589-9666
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $21.00
Trade Permit Base Fee $55.00
Total Payments: $80.00
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 n
r^�[] ) pPh(904)247-5826 Fax(904)247-5845
JOB ADDRESS: lY ,) I !� �� 3� a 33 PERMIT#
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NEW OR REPLACEMENT INSTALLATION: Project Values OP00
TYPE OF FIXTURE QTY TYPE OF FixTORE 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
RE-PIPE: TYPE
TYPE OF FIXTURE QTY TYPE OF FixruRE 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
**SMWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ Other
Permit becomes void if work does not commerce,within a six month period or work is suspended or abandoned for six months.1 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 rot The permit does not give authority w XOL'e die proision of any other store or local law regulation wromuction or the perfor anc%of wnstmction.
Property Owners Name �'T'TI �_a_ _ Phone Number �l�l"tLF—��o�_-
Plumbing Company �Q 1� _ 2 r Office Phone $9_ q V Fax, l- ��l{
Co. Address: LAA 0, " vrWlourt�V- n city !.e•enCbV-C State�Lzip 'JaoN3
S K eeI e
License Holder(Print): .Ta'^'�t State Certificauon/ltegistmtion# C FC�58Of79
Notarized Signature of License Holder '1
SUSAN JOHNSTON,CNotary Public Sworn aztd subscribed befo me this day of 20�
y te Cor f wsinMichigan, County of Chale AAYY1lll�l�l parr •U�/•bU•Jdll(=J-h•\1
My Comnnasion Ezpirea 0&132019 Signature of Notary Publi
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Fo
L!.%l r�^ ATLANTIC BEACH
PERMIT RECEIPT
p September 14,
2016
PERMIT DESCRIPTION: PLUMBING-3 FIXTURES
PERMIT NUMBER: 16-PLBG-2065
ADDRESS:29216TH ST
OWNER:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $21.00
Trade Permit Base Fee $55.00
Totals: $8000
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