1714 ATLANTIC BEACH DR - PLUMBING j i.,:- l J
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,, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
j� ` ;� ATLANTIC BEACH, FL 32233
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INSPECTION PHONE LINE 247-5814
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PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-2794
Job Type: PLUMBING ONLY
Description: PLUMBING - 23 FIXTURES
Estimated Value:
Issue Date: 12/14/2016
Expiration Date: 6/12/2017
PROPERTY ADDRESS:
Address: 1714 ATLANTIC BEACH DR
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: DARLEYS PLUMBING INC.
, CFC056702
Address: 4472 PHILLIPS HWY QA CARL LESLIE DARLEY
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $161.00
Trade Permit Base Fee $55.00
Total Payments: $220.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233 •
Ph(904)247-5826 Fax(904) 247-5845 1 (p -- PL 6 G1-279 4-
JOB ADDRESS: 1-11 1 4re .)- c. ,VA—c4. nn- PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub —11-__ Septic Tank&Pit
Clothes Washer __L_ Shower –1--
Dishwasher _ Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet N
Hose Bibs 2 Urinal
Kitchen Sink _I.__ Vacuum Breakers
Laundry Tray _I—_ Water Connected Appliances 2
Lavatory 6 Water Heater I
Other Fixtures 4, Water Treating System _I,_
RE-PIPE:
TYPE OF FIXTURE 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:
o Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
o Lawn Sprinkler System-Number of Heads 0 Well **
**SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ 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 state or local law regulation construction or the performance of construction.
Property Owners Name i Pl.. r7 ) Phone Number
Plumbing Company 6;--
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Co. Address: ���-c�- c City rA`�State t���
Holder(Print): 1 Certification/Registration#License o (P ) Cciv % ' 6 /tate
nse Holder CA
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�1Votar�zed Signatureof Lice_ lel
' i'�►r"Pw.,,,, JOANNE MEHL I Sworn and subscribed before 1 e this 12 ' day of I/ 20/6
> 41,� Notary Public-State of Florida
Commission St GG 02i781 Signature of Notary Public i.,W 11%f,,„ � ��' My Comm.Expires Aug 29.2020 ! \
1 _ ,,,- _Btu-:ae1 ternugh National Notary Assn.
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