1786 Atlantic Beach Dr plbg permit 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
JOB INFORMATION:
Job ID: 16-PLBG-2611
Job Type: PLUMBING ONLY
Description: install 27 fixtures
Estimated Value:
Issue Date: 11/21/2016
Expiration Date: 5/20/2017
PROPERTY ADDRESS:
Address: 1786 ATLANTIC BEACH DR
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: DARLEYS PLUMBING INC.
, CFC056702
Address: 4472 PHILLIPS HWY QA CARL LESLIE DARLEY
Phone: -
FEES:
Plumbing Fixtures $189.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $248.00
PERM IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845
JOB ADDRESS: I I Jib� g, q I b-PERMIT
a e
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPEOFFDauRE Q7T TYPEOFFL1f m QTY
Bathtub .3 Septic Tank&Pit
Clothes Washer I Shower 7
Dishwasher 1 Shower Pan _
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs _ Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray E Water Connected Appliances L
Lavatory Water Heater 2
Otherfix[mes/&m Ig�t —S— Water Treating System 1
RE-PIPE:
TYPEOFFEavRE QTY TYPE oFFIXTURE QTY
Bathtub Septic Tank&Ph
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 Weber Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
D Sewer Replacement D Back Flow Preventer D Grease Interceptor(Trap) gallons(Requires 3 sets of plana)
D Lawn Sprinkler System-Number of Heads D Well •'
**&IRWD Well Completion Form.Completed form to be submitted to the Building Department for final inspection.**
D Other
Permit becomes void if work does not commerce within a six month period or work is suspended or abandoned fm six months.I hereby certify that I have read
this application and know the same[,be we and correct All pmvisions of laws and ordinances governing this work will be complied with whether specified
or not The permit does not give authority m violate the provisions of my other some or local law regulation construction or the performance of mnsmucti m.
Property Owners Name T r-c. 7.) Phone Number
Plumbing Company ' Offic Fax &:W
Co. Address: city the R—Zip •
License Holder(Print): tate cation/Registration# 04F( D
Notarized Signature of License Holder
o"••f
JOANNE MENx Sworn and subscribed before a this } day of tJ JR,.T %'u 20�
• N01ary Pualit Stale 01 Flwki
Signature
Commiarla0 r GG 02Signature of Notary Public
1781
a My Comm.
Bmlose,Aug29,2020
T, aea IlaoulA ,A g 29 2010.