1695 Selva Marina Dr plbg permit CITY OF ATLANTIC BEACH
1 800 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-1932
Job Type: PLUMBING ONLY
Description: PLUMBING -29 FIXTURES
Estimated Value:
Issue Date: 8/24/2016
_ Expiration Date: 2/20/2017
PROPERTY ADDRESS:
Address: 1695 SELVA MARINA DR
RE Number: 171999-0000
PROPERTY OWNER:
Name: MAXINE MANLOVE, RICHARD HELLER
Address: 1695 SELVA MARINA DR
GENERAL CONTRACTOR INFORMATION:
Name: NELSON PLUMBING CO. INC.
Address: 11624 -1 DAVE DAVIS CREEK RD QA SCOTT GARY
NELSON
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $203.00
Trade Permit Base Fee $55.00
Total Payments: $262.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax (904)247-5845 1 62-P c- QG - 19 3 z
JoB ADDRESS: 1495- (_VA Qtfe& 91- PERMIT# 16- 9f1Z- IYII
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPEot,FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower 2
Dishwasher Shower Pan L
Drinking Fountain Slop Sink _ 2-
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater Z.
Other Fixtures Water Treating System I
RE-PIPE:
TYPE oFFfXTURE QTY TYPEoFFIXTURE 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:
D Sewer Replacement D Back Flow Preventer D Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
D Lawn Sprinkler System-Number of Heads D Well `•
**SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
D 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 rovisions of any other stale or local law regulation construction or the performance of construction.
Property Owners Name- r #I AwuVE FI Ell_F 2 Phone Number
Plumbing Company /VE(So,J RuInA il6 (nD 7. 1c. Office Phone Z62, U Fax
Co. Address: Z. — LrA C' wJf��( State Zip -t
License Holder(Print): Ir /V t ertification/Registration# 02U *9'7q
N Holder
t; srcmawssaaarFwmaz Before me this day of 20� �e
. aeXPJREs:N Flran 16�
Odnhr, Signature of Notary Public ct4
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