2021 Selva Madera Ct plbg permit CITY OF ATLANTIC BEACH
lVNy,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-2670
Job Type: PLUMBING ONLY
Description: relocate cpvc water supply for residential addition
Estimated Value:
Issue Date: 11/29/2016
Expiration Date: 5/28/2017
PROPERTY ADDRESS:
Address: 2021 SELVA MADERA CT
RE Number: 169506-1650
PROPERTY OWNER:
Name: BURBRIDGE, H CLINTON
Address: 2021 SELVA MADERA CT
GENERAL CONTRACTOR INFORMATION:
Name: MIKE SANVILLE PLUMBING INC
,CFC057340
Address: 530 ELLIS RD STE 212 QA MICHAEL RAYMOND
SANVILLE,II
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: $66.00
PERMIT IS APPROVED ONLY M ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
11141 800 Seminole Rd Atlantic Beach,FL 32233
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Ph(904)247-5826.-5Fax(904)247-5845 Ib-P�BL� ' a b-t(�
JOB ADDRESS: /l(CA // .tin .P(t",L �(�t Jzt� PERMIT#
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NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE oFFIXTURE QTY TYPE oFFDavRE 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
RE-PIPE:
TYPE oFFEY AE QTY TYPE OF FIXTURE 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 i7 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well **
**S1KJ)'9 WD Well Completion Form. Completed form to be submitted to the Building Department for rural inspection.**
tither l&/QCr' 4e.. CO(IC LJr 6 514Q)k j
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 m be true and correct. All provisions of laws and ordinances governing this work will he complied with whether specified
or not. The permit does not give au[bon to violate thiisions of any other state or local law agulation construction or the performance of construction.
Property Owners Names Phonee Number
Plumbing Company�Y,//�_�- � j I ffice Phone 30 y-o ZFax, =],Z
Co.Address: S(1 kll"I 2 /2 City cl&e Stat Zip?
License Holder(Print): �`[ r' a�tate rtificat��egistration s�.xrU
Notari ed Si Lder
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JFNNIFEalnNNSTGN
MYGGMMISSION t GG W29aa Before me this_ day of I�UV2mk14-f 20 )10
# EXPIREN: PU%2T,2JZ0 p
mwaTNaxoaywarcuM.rwx.r Signature of Notary Public