1285 Camelia St plbg permit -i Iy1JyJy�i
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
IOBINFORMATION:
lob tD: 16-PLBG-2475
Job Type: PLUMBING ONLY
Description: connecting to city water & sewer system - impact fees
previously paid under 16-RAAR-1877
Estimated value:
Issue Date: 11/4/2016
Expiration Date: 5/3/2017
PROPERTY ADDRESS:
Address: 1285 CAMELIA ST
RE Number: 171051-0050
PROPERTY OWNER:
Name: Management Systems, Mandarin
Address: 820 MCCOLLUM CIR
GENERAL CONTRACTOR INFORMATION:
Name: ADVANTAGE PLUMBING
Gregory K.Gause,CFC1425959
Address: 880 MAYPORT RD QA GREG GAUSE
Phone: -
FEES:
Plumbing Fixtures $7.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $66.00
PERMIT IS APPROVED ONLV IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 FM(904)247-5845
doB ADDREss:�0��5' Il -QJm,0 to I �- RMIT .I -a�(�S
°�--�� PERMrr#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FI URE QTr TYPE OF F/;;; Q
TY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three compartment Sink —
HowFlooSink Toilet P —
Hose Bibs —' Urinal
Kitchen Sink
LaundryVacuum Breakers _
Otherer Fixtures
Tray Water Connected Appliances hWater Heater _—
Fixtures Water Treating System
RE-PIPE:
TYPE OFFIXTORE QTY TYPE OFFmwRE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower —
DishwasherShower Pan
Drinking Fountain Slop Sink _
Floor Sink —
Floor Drain Three Compartment Sink
Hose Bibs Toilet —
Urinal
Laundry
Sink Vacuum Breakers —
La ry Tray Water Connected Appliances
Other Lavatory tores Water Heater
Water Treating System _
MISCELLANEOUS:
❑ Sewer Replacement ❑Back Flow Preventer ❑ Grease Interceptor(Trap)_gallons g (Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well •>
••SJRWD Well ComPledon Form. Completedlform to be submitted to the Building Department for final inspection."
❑ Other. SPIR_ �SPG//G ry �
Permit becomes void if work does not commence within a six month period or work is suspended or abandoned for six months.t here
this application and know the same to be one and correcL All provisions of laws and ordinances governing this work will be complied with whetherhpwifiave ed
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-64 IQ YA 4n1mo if &Apgt�S. Phone Number Ma-,6/o5 2
Plumbing Company - J Office PhoneaYT98YrS F
axe9
Co. Address: E �1 CityL• 13j- State 0 ,Zip.lw33
License Holder(Print): C U State Certification/Registmtion#C)f" 'lgpSTC2
Notarized Signature of License Holder
JeNwrtRJoNNsrpN efore me this_ day of 012-M bQ-( 20 I b
rxap+Fs onro«a•ano ignature of Notary Public
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