615 Amberjack Ln 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-2307
Job Type: PLUMBING ONLY
Description: BACK FLOW PREVENTER
Estimated Value:
Issue Date: 10/14/2016
Expiration Date: 4/12/2017
PROPERTY ADDRESS:
Address: 615 AMBERJACK LN
RE Number: 171186-0000
PROPERTY OWNER:
Name: DENNIS, JAMES R
Address: 4641 WHITES PT
GENERAL CONTRACTOR INFORMATION:
Name: AMERICAN WELL & IRRIGATION INC
,W-36 & 1-6
Address: 49 ARDELLA RD OWNER JOE CONSELICE
Phone: 904-237-3454
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: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845 _P L6 G -'2.3 07
aDB ADDRESS: I �mher a c K 1n . PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPEOFFIXTURE QTY TYPEUFFUTURE QTY
Bathtub
Clothes Washer Septic Tank&Pit
---
Dishwasher ShowerShower Pan
Drinking Fountain Slop Sink
Floor Sink Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers _—
Laundry Tray, Water Connected Appliances
Other
LaveWater Heater
Fiflxtures Water Treating System
RE-PIPE:
TYPEOFFIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes WasherShower
Dishwasher Shower Pan
Drinking Fountain Stop Sink
Sin
Floor Sink
Floor k Three Compartment Sink
Hose Bibs Toilet
Urinal
Kitchen Sink Vacuum Breakers
Laundry TrayLavatWater Connected Appliances
Other 7 Water Heiner
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement 1J Back Flow Preventer O Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well
""VRWD Well Completion Form. Completed form to be submitted to theIBw�' ding Department for final inspection."*
❑ Other
I'Cralit becomes void If work does not commence within a sin month period or work is suspended or abandoned for sin monthm l hereby certify did I have reed
this application and know the serve to be true and cowett All provisions of laws and ordinances governing this work will be complied with whether specified
Of not The penton does not give authority to violate the pmvislons of any other nam or local law regulation construction or the performance of contraction.
Property Owners Name " � Phone Number 9(/1_ -L 5—
J8,20 J)DJAIniOn 3 77
)
Plumbing Company ! II11Cr1 C= P.1 ' I Ir WAIDffic�Phone J"- C��JF'a}x •81I(p
Co.Address: City i State 1 LZip
License Holder(Print): C-P� State CettiSca ion/Itegistration# _
Notarized Signature o i der
^«" �°EVE,:f�+ and subscribed befot��f 2p
r EXPIflES Ocbbar a�Yo+a
,�; a�ase*.ua=wr^�°'v1n°'"""' ignature of Notary Public