1626 Maritime Oak Dr plbg permit CITY OF ATLANTIC BEACH
J 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-2140
Job Type: PLUMBING ONLY
Description: install water treating system
Estimated Value: $229.00
Issue Date: 9/23/2016
Expiration Date: 3/22/2017
PROPERTY ADDRESS:
Address: 1626 MARITIME OAK DR
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: HYDRO MEDIX TECHNOLOGIES INC
,TBA
Address: 10940 US HYW 1 N Suite SUITE
Phone: 904-230-6393
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $7.00
Trade Permit Base Fee $55.00
Total Payments: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
rn1 Phl(904)247--5�8�26 }Fax (904)247-5845
JOB ADDRESS: , �A y�1 t Y-I T1 � 1.W e c U Y- PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$=-6D
TYPE oFFIXTI/RE QTY TYPE oFFLxTURE 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 oFFIXTT/RE QTY TYPEoFFIXTI/RE 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.**
❑ Other
Permit becomes void if work does not coimmnce within a six month period m 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 my other state or local law regulation construction or the performance of construction.
Property Owners Name C1CAmMe 1nlxyx<nh s Phone Number g11- '97`I-3331
Plumbing CompanyOly� o M Oly �&C k Office Phone 9+,Z6-01`3 Fax
Co.Address:Ing3k U5 &Y1 city PDn4e Jjel;6 state) Zip '0i21
License Holder(Print): L C`a4 a State Certification/Registration#
Notarized Signature of License Holder
tests� s Sworn subscribed before me this ? day of 20
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EVIPES.C.Mter 5.2019 Signature of Notary Pul
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