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2233 SEMINOLE RD #20 - Plumbing i CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 1) i PLUMBING PERMIT MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814 ]OB INFORMATION: Job ID: 16-PLBG-2221 Job Type: PLUMBING ONLY Description: 12 Fixtures: Bathtub, Clothes Washer, Dishwasher, 2 Hose bibs, Kitchen Sink, 3 Lavatories, Shower, 2 Toilets. Estimated Value: Issue Date: 9/30/2016 Expiration Date: 3/29/2017 PROPERTY ADDRESS: Address: 2233 SEMINOLE RD UNIT 020 RE Number: 169519-0138 PROPERTY OWNER: Name: Shorstein, Michael A Address: 2961 Mandarin Hollow DR GENERAL CONTRACTOR INFORMATION: Name: C W WOOD PLUMBING ,CFC057097 Address: 1328 ROMNEY ST OA WALLACE SCOTT WOOD Phone: - FEES: State PLMG DBPR Surcharge $2.00 State PLMG DCA Surcharge $2.00 Plumbing Fixtures $84.00 Trade Permit Base Fee $55.00 Total Payments: $143.00 PERMIT IS APPROVED ONLY W ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLOMA BUILDING CODES. t a- PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach,FL 32233 Ph(904)247-5826 Fax(904)247-5845 JOB ADDRESS: Z Z 3 3 Al "�iO PERMIT NEW OR REPLACEMENT INSTALLATION: Project Value$ TYPE oFFIXTORE QTY TYPE oFFIXTORE QTY Bathtub Septic Tank&Pit Clothes Washer Shower Dishwasher �— Shower Pan Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet Z-- Hose Hose Bibs Z Urinal Kitchen Sink Vacuum Breakers Laundry Tray Water Connected Appliances Lavatory Water Heater Other Fixtures Water Treating System RE-PIPE: TYPE oFFixTURE QTY TYPE of FIXTORE QTY Bathtub Septic Tank&Pit Clothes Washer Shower Dishwasher Shower Pan Drinking Fountain Slop Sink Floor Drain Thee 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 ** **S/RWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.** ❑ 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 some to be true and correct. All provisions of laws and ordinances governing this work will be complied with whether specified or noL The permit does not give ambond o violate the provisions of any other slate or local law regulation wnstruction or the performance of construction. Property Owners Name ///'" "kt /S 'r� 'ne Phone Number Plumbing Company ! l� WGY�U ��J�a6 Office Phone yam'^'/ Fax Co. Address: lata ADinl W S7 . ily T.I �' State/Fa"r- Zip 37Z// License Holder(Print): - GAJ J State Certifjcati egistmtion#4: �eo57;Vf7 Notarized Signature o Lice r der 13INDIESPERGEa s. ur=ISSIONOF924W efore me this ZC day 0 EXPIRES:Uses,a 2019 �sr,;rv.. ao,aprnnaaarrPv&uner..naa ignature of Notary Public i CITY OF ATLPoITIC BEACH 800 SEMIN L RORO PHONET1904) 47-F56"oa 32233 Cashier Id: atlhcldWtIhcct I� Receipt Receipt Womb;': OS-""704:47:26 PM Joh ID: 16-PLBG-7121 - 12 Fixtures: BathtubCluts I Ki tcheneSirdigh3 Lavator Icser5ham•.e26Toiile M% DBPR Surcharge $2. ts, POBPR - State PL 00 Joh ID: 16-PLBG-2221 - 12 Fixtures: Bathtub Clothes Washer, Dishwasher, 2 Hose bibs, - Toile tsthn cPeBCASi State`PLLMG DER Surcharge Shover 2 32'00 Job ID: IG-PLBG-2221 - 12 Fixtures: Bathtub ClotKi tcheneSink 3 Lava cries�Show,e2 Toile ta. PL1 - Plumbing Fixture 584.00 Job ID: 1&-PLM-2Z21 - 12 Fixtures: Bathtub Clothes Washer, Dishwasher2 Hasa kitchen TP Sink,Trade3Permit • ? Lavatur les,Bax Fm $55OOoile ts Rmount Due: $143.00 Tender Information: Cash $143.00 Tender Type: CC Tender Amount: $143.00 Change Due: $0.00 I