623 Selva Lakes Cir plbg permit 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 INSPECnION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-2113
Job Type: PLUMBING ONLY
Description: PLUMBING -2 FIXTURES
Estimated Value:
Issue Date: 9/21/2016
Expiration Date: 3/20/2017
PROPERTY ADDRESS:
Address: 623 SELVA LAKES CIR
RE Number: 172027-5554
PROPERTY OWNER:
Name: CORBITT, TERESA BOYKO
Address: 623 SEI LAKES CIR
GENERAL CONTRACTOR INFORMATION:
Name. DAVID GRAY PLUMBING INC.
David Fred Gray,CFCO22586
Address: 6491 S POWERS AVE QA 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: $73.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
I^ Ce Ph(904)V247-582p6 Fax (904)247-5845 I (o- PLBG-Z 03
JOB ADDRESS: (�Z3 JC A LfAres Grt,f PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPEOFFLYTURE 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 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 ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well "
** SIRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
8'Othe ^ r/
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 mad
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 ambmity to violate the provisions of any other stale or local law regulation construction or the performance of construction.
Property Owners Name 6,+r Phone Numberq0(_ 30-_%1
Plumbing Company UAV+fi� rsYG.ul'YI�^bl^Gt �nL Office Phone'1�1'�Ly'7711 FaxgrMl' '�7Fi
Co. Address:. POdGfS /�'Jinlw.l City J0tc 5#e%,A14 State F-Zip32219
License Holder(Print): UI State Certification/Registration# Cr-c# z%
A Ider
Wendy
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My(N,vmw� Fr 133578 Sworn and subscribed before me[his a���day/of�T � 20
a.aa«od+rrm+° Signature of Notary Public 9-- t I v