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363 12th St plbg permit -SI CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD j - ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 PLUMBING PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 ]OB INFORMATION: Job ID: 16-PLBG-2183 Job Type: PLUMBING ONLY Desorption: PLUMBING - 37 FIXTURES Estimated Value: Issue Date: 9/28/2016 Expiration Date: 3/27/2017 PROPERTY ADDRESS: Address: 36312TH ST RE Number: 171917-0000 PROPERTY OWNER: Name: SIMEONIDIS, SERGE Address: 363 12TH ST GENERAL CONTRACTOR INFORMATION: Name: CUSTOM PLUMBING AND TILE ,CFC1427389 Address: 2742 SETTLEMENT DR QA THOMAS MICHAEL BLACKBURN Phone: FEES State PLMG DBPR Surcharge $2.00 State PLMG DCA Surcharge $2.00 Plumbing Fixtures $259.00 Trade Permit Base Fee $55.00 Total Payments: $318.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WFFH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph(904) 247-5826 Fax(904)247-5845 { (o _PL RC JOB ADDRESS: 363 �.Z �� PERMIT# C7-� NEW OR REPLACEMENT INSTALLATION: Project Value$ TYPE oFFIXTURE 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 -1 Hose Bibs _ Urinal Kitchen Sink / Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory Water Heater Other Fixtures Water Treating System RE-PIPE: TYPEOFFIxTORE QTY TYPE of F/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 •* **SIRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.** ❑ Other Nls✓ AA-Z jl; v /;J ya.e.✓. 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 provisions of any other I state or local law regulation construction or the performance of construction. Property Owners Name M t '�a� ke L R a f' Phhpyo��ne,Number Plumbing Company 144'1 1/m/ �wt/t.�7rtih �• if Office Phone Owr�fr7 Fax Co. Address: City _Stage-Zip 3zet c— License Holder(Print): 1,&AoLctr State Certification/Registrmion# 73$ Notari [der TCNIGINOlE3PEPGEf1 :�€""'� nrrcorranlssloNrFfez°ss+ eforemethi ayo 2 I'� FXPIPES'.OdoEar B.2019 �^ �• aanEW IMU NYaYPubOCUMsm'rAeis `tALS.� ignatwe of Notary Public