2027 Selva Madera Ct plbg permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
s
r _ � 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-2703
Job Type: PLUMBING ONLY
Description: re-pipe 19 fixtures
Estimated Value:
Issue Date: 12/5/2016
Expiration Date: 6/3/2017
PROPERTY ADDRESS:
Address: 2027 SELVA MADERA CT
RE Number: 169506-1648
PROPERTY OWNER:
Name: BURNS, PATRICIA JEAN
Address: 2027 SELVA MADERA CT
GENERAL CONTRACTOR INFORMATION:
Name: WAYNE CONN PLUMBING INC.
Vernon 1.Sparks,CFC1428564
Address: 6915 W BEAVER ST
Phone: -
FEES:
Plumbing Fixtures $133.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $192.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
nn Ph(904)247-5826 Fax (904)247-5845 (0_PL 6&1 _ a-03
`
JOB ADDRESS: a 7 ,)G ///,y /'l /9d C/Z PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE oFFIXTuRE QTY TYPE oFFLYTURE 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 of FIXTURE QTY TYPEOFFIXTuRE 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 Trayrel Water Connected Appliances
Lavatory Water Heater !
Other Fixtures Water Treating System
MISCELLANEOUS: � 9
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ Other
Permit becomes void ifwork 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 one and cortecl. All provisions of laws and ordinances governing this work will be complied with whether specified
or not The permit does not give authority to violate the provisions of any other slate or local law regulation construction or the performance of construction.
Property Owners Name /• S P's In 6/ -'reon n UlI YnS Phone Number
Plumbing Company l�//d.;. ffice Phone 3.� Fax
Co. Address: City f - State g-/Zip
License HolderPrint : � aa+✓ s�'�'Ch d � /
( ) ✓" State Certification/Registration /y,Z�w�
Notarized Signature of License Holder
c a
BW8 Before me this day of,—20
STEPRAME
ay fFF 190512
* "
EXPIRES:May 15,2019 Signature Of Notary Publi
0 ykP` aEX IRES:May1 ,2019