2251 N Fairway Villas Ln plbg permit . ?SL-Llij�a
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
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-2047
Job Type: PLUMBING ONLY
Description: install new tub, shower pan
Estimated Value:
Issue Date: 9/13/2016
Expiration Date: 3/12/2017
PROPERTY ADDRESS:
Address: 2251 N FAIRWAY VILLAS LN
RE Number: 169398-1084
PROPERTY OWNER:
Name: CARRUBA, PHILIP
Address: 2251 N FAIRWAY VILLAS LN
GENERAL CONTRACTOR INFORMATION:
Name: DAVID GRAY PLUMBING INC.
David Fred Gray,CFCO22586
Address: 6491 S POWERS AVE CIA DAVID FRED GRAY
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $14.00
Trade Permit Base Fee $55.00
Total Payments: $73.00
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 SeminoleRdAtlantic Beach,FL 32233
Ph(904) 247-5826 Fax(904)247-5845
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JOB ADDREss: ( A5 I 6,I/w&u�1I IFAS U1• /AV r PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value S
TYPEOFFfXTURE 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
RE-PIPE:
TYPEOFF/XTURE QTY TYPE OFF/XTURE 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 "
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
Other Q / 0C/i.-l'L r,+6+Xfn WCSjz arVt WG�/
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 reed
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 of any other state or local law regulation construction or the performance of construction.
Property Owners Name, PP 5 51, C& m/I J-�,'n pP�hho�ne Nlu'mber 'I(�J%-kdto
Plumbing Co/m/--p'an'rv.11 V y � t�17i/Yn A1C. Office Phone9til 72'1-72.!IF on,9.0! t25
Co. Address:l4�I Qo w"� . J City )Gf Je50nv'I It State f-1, Zip 32-LI
License Holder(Print): State Certification/Registration#L94 12-5
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Notarized Signature oJLicense Holder
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