2220 Beachcomber Tr plbg permit �,
800 SEMINOLE ROAD
3 ATLANTIC BEACH,FL 32233
lot)
� CITY OF ATLANTIC BEACH
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-2165
Job Type: PLUMBING ONLY
Description: PLUMBING - 23 FIXTURES
Estimated Value:
Issue Date: 9/27/2016
Expiration Date: 3/26/2017
PROPERTY ADDRESS:
Address: 2220 BEACHCOMBER TR
RE Number: 169463-0048
PROPERTY OWNER:
Name: KAPLEY, KENNETH K
Address: 2220 BEACHCOMBER TR
GENERAL CONTRACTOR INFORMATION:
Name: MIKE SANVILLE PLUMBING INC
,CFC057340
Address: 530 ELLIS RD STE 212 CIA MICHAEL RAYMOND
SANVILLE,II
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $161.00
Trade Permit Base Fee $55.00
Total Payments: $220.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax(904)247-5845 -P _ Z I(2,5
JOB ADDRESS: 22,,2 n - �4 PERMIT#IL-014 Ifft.
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OFFrxTuRE QTY TYPE OFFixTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower _
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Tbree 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: �I
TYPE oFFixTaRE QTY V TYPEOFFixTuRE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Tbree Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Z 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 Cl Well ••
** SJRWD Well Completion Form. Completed form to be submit/(ed to tthhe7Building Dep f ent for final inspection.**
❑ Other R��� 1 rya k. �+�Mec�e / / I <Y,,3 %t // �W-c-
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 my other state or local law regulation construction or the performance of construction.
Property Owners Name Phone Number
Plumbing Company 1' & Office Phone JE Y- ax / 7Ja�'r�
6'
Co. Address: S�(Z �����//���.� oZ/oZ City .��� Smt�Zip7
License Htolder(Print): l- C V✓/l2 Stat Certificafi tl/Registmtion#�V
Notarized Signature of License Holder
my nrT ff fntml Before me this��day o 20
= EXPIRES:nclohar 6,2019
''•aif. aonxamm w,urvmreu.e..«uo Signature of Notary Public