2233 Seminole Rd #3 plbg permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
9
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-2204
Job Type: PLUMBING ONLY
Description: PLUMBING - 2 FIXTURES
Estimated Value:
Issue Date: 9!30/2016
Expiration Date: 3/29/2017
PROPERTY ADDRESS:
Address: 2233 SEMINOLE RD UNIT 003
RE Number: 169519-0106
PROPERTY OWNER:
Name: GEBHARDT, KURT
Address: 2233 SEMINOLE RD APT 3
GENERAL CONTRACTOR INFORMATION:
Name: M &A PLUMBING INC
Phillip O. Dennis,CFC046207
Address: 1186 PECAN COVE KENNETH BRENNAN
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: $73.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826// Fax(904)247-5845 7 (p 'P LE G—ZZ0 4
JOB ADDRESS: ci�Z33 J;zjth o/z "o°K! U� l PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OFF/XTURE 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 TrayWater Connected Appliances
Lavatory �— Water Heater
Other Fixtures Water Treating System
RE-PIPE:
TYPE of FIXTURE QrY TYPE OFFLYTURE 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
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 authority to violate the provisions of any other state or local law regulation construction or the Performance of construction.
Property Owners Name k V "`CL4 _Phone Number
Plumbing Company Office Phone 07 J• Fax
Co.Address: 1Y3' � Y� City Z_ _State&�Zip
License Holder(Print): State Certification/Registration# h O O
Notarized Signature o older
Toa�s �su Before me[his�y f 20
9r� ao�aeernry w�.,'r�an°°"""" Signatlre of Notary Public