1804 Atlantic Beach Dr plbg permit CITY OF ATLANTIC BEACH
's 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
]OB INFORMATION:
3obID: 16-PLBG-2411
lob Type: PLUMBING ONLY
Description: install 22 new fixtures
Estimated Value:
Issue Date: 10/26/2016
Expiration Date: 4/24/2017
PROPERTY ADDRESS:
Address: 1804 ATLANTIC BEACH DR
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: NELSON PLUMBING CO. INC.
Scott Nelson,CFCO20379
Address: 11624 -1 DAVE DAVIS CREEK RD OA SCOTT GARY
NELSON
Phone: -
FEES:
Plumbing Fixtures $154.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $213.00
PERMIT IS APPROVED ONLY IN ACCORDANCE IVIED ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904) 247-5845
n ^ pp lb'pLf3G�—aV,��
JOBADDRESS: ` gotl ATLAPVril 9,PA .H DD _ PERMIT# 16-SFp_'Z-0J�
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE of FIXTURE QTY TYPE oFFixwRE QTY
Bathtub Septic Tank&Pit
Clothes Washer _� Shower 2-
Dishwasher �_ Shower Pan 1
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs 'L Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray Water Connected Appliances I
Lavatory 5 Water Heater
Other Fixtures Water Treating System �.
RE-PIPE:
TYPEoFFixTURE QTY TYPE OFF/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 **
**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 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 authtotrity b violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name 1 FtVEES(og AOW1cc Phone Number
Plumbing Company NGLSool PLumdielL I$ :'wL. Office Phone 76Z .i(88V Fax
Co.Address: 1 Zq 4 DA& jf&46- 06 r CityI-v State_LZip _$1,_J
License Holder(Print): govvCertifrcation/Registmfion# OLD279
Notarized Si nature oCkjQq
A;lg,,Qlder
;V51 v,t lB1P.B�186
��yyyy MYGMssslaa+PP2 1 efore me this day of P/1�
i"yi49X.v? EXPIRE&Nwen ,16,2x19if
>,ar DrsWll*w.r Poo*we..am. ignature of Notary Public