235 N Oceanforest Dr plbg permit CITY OF ATLANTIC BEACH
800 SENHNOLE 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-2834
Job Type: PLUMBING ONLY
Description: install/repair tub, 2 lavatories, 2 toilets
Estimated Value:
Issue Date: 12/19/2016
Expiration Date: 6/17/2017
PROPERTY ADDRESS:
Address: 235 N OCEANFOREST DR
RE Number: 169463-0090
PROPERTY OWNER:
Name: Khadivi, Kyle
Address: 235 Oceanforest DR
GENERAL CONTRACTOR INFORMATION:
Name: KELLEY'S PLUMBING CONTRACTING
,RF11067509
Address: 3866 VALENCIA RD MICHAEL RYAN KELLEY
Phone: -
FEES:
Plumbing Fixtures $35.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $94.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904)247-5845 b- PLEtzi- a83y
JOBADDRESS: 2>4�- JCt'Arp�>-,V '4—A7 PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$ -
TYPEOFFLYTURE QTY TYPE oFFDavRE QTY
Bathtub —L 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 oFFIXTORE QTY TYPEoFFixTOBE 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 Tiny 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 **
**SIRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
o 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 authority to violate the provisions of any other slate or local law regulation construction or the performance of construction.
Property Owners Name /r—J '�jy l Phone Number
Plumbing Company KC/.tEV$ 1�(u^ r�i,4.� Cd,,-,9PObti I,)C Office Phone Fax
Co.Address: 38(A-p shkwryL 70-� �6- City Jn k State FL Zip 3ZZO'S'
License Holder(Print): miu ! kZ-Zw'if State 'flcation/Registmtion#
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FgRWEB:Iktoler T!,NZ10 Before methis1 dayof D&L vy) bB-r 20 M
BptlitltlT1NN0bry�` � Signature of Notary Public U u V Q�-