1652 COQUINA PL - PLUMBING '' �� 1 CITY OF ATLANTIC BEACH
, .0 1SJ 800 SEMINOLE ROAD
!<11, 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-2791
Job Type: PLUMBING ONLY
Description: install washer & water heater
Estimated Value:
Issue Date: 12/14/2016
Expiration Date: 6/12/2017
PROPERTY ADDRESS:
Address: 1652 COQUINA PL
RE Number: 169579-1020
PROPERTY OWNER:
Name: MAZOR, MARVIN AND ROSEMARIE, *
Address: 1652 COQUINA PL
GENERAL CONTRACTOR INFORMATION:
Name: WATSON PLUMBING
Miles Edward Carlyon, CFC057664
Address: 4456 SUNBEAM RD APT 200 MILES CARLYON
Phone: - -
FEES:
Plumbing Fixtures $14.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $73.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACII ORDINANCES AND THE FLORIDA
BUILDING CODES.
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PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845 ko— PL gG _a-4., 1
JOB ADDRESS: Vo S a Co Ca3 u I A ‘)1- • PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer ____L__ 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 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 o Back Flow Preventer o Grease Interceptor (Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads 0 Well **
** SJRWD 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 state or local law regulation construction or the performance of construction.
Property Owners Name --t,1 (-�N __ 6 0 N.(fit N nL C) Phone Number of S4 -3n- 7l d 7
Plumbing Company LOA-I-Soc.& Q (um bi ..ic., Office Phone 7374. 3 7 Fax?39e1"i!o gal
Co. Address: 4L (d-Z:loo S 0/
N1 1/411 (4. City .acP,kSoty.v ail— State Ft Zip Slag)License Holder(Print): 11 / Air ' ' D4 t Ce 'fication/Registration# CrC64
�� raS7 Notarized Signature of License Holder .( / —�
?01.:;'8e,,, 10=t1Y BAUM' Sworn and subscribed before me thi /1-# day of b'P e . 20A
MMY COMMISSION t FF 097166 Atagt
.. EXPIRES:March 2,2018 Signature of Notary Public
�'*4 Balled Thru Budget Notary Unites