1528 PARK TERR W - PLUMBING ..,,\J„
t)
' � ''= _,,
�st, CITY OF ATLANTIC BEACH
. 800 SEMINOLE ROAD
J '' N ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
Ji),l9r'
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-PLBG-2910
Job Type: PLUMBING ONLY
Description: PLUMBING - 1 SHOWER POAN
Estimated Value: $1,500.00
Issue Date: 1/3/2017
Expiration Date: 7/2/2017
PROPERTY ADDRESS:
Address: 1528 W PARK TER
RE Number: 171939-0000
PROPERTY OWNER:
Name: GHIOTTO,PHILIP M & ELIZABETH B, *
Address: 1528 PARK TER
GENERAL CONTRACTOR INFORMATION:
Name: KIMBALL PLUMBING, INC.
Mark Edward Kimball, CFC057897
Address: 12024 SUNOWA SPRINGS TR QA MARK EDWARD
KIMBALL
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $7.00
Trade Permit Base Fee $55.00
Total Payments: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
K IAA ba_((3 i -,
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
�y Ph(904)247-5826 Fax(904)247-5845 `
JOB ADDRESS: 27' C�.t/ i 7 - P LSG, Z9 I D
IL 'j".e vv (�� _ PERMIT#
NEW OR REPLACEMENT INSTALLATION:
Project Value$1'500 , Oi
TYPE or FIXTURE Qry — -
Bathtub TVPEOFFIXTURE QTY
Clothes Washer Septic Tank&Pit
Dishwasher Shower
Drinking Fountain Shower Pan
Floor Drain
Slop Sink -�---
Floor Sink - Three Compartment Sini
Hose Bibs — — Toilet
Kitchen Sink Urinal `--
Laundry Tray Vacuum Breakers `
Lavatory ----— Water Connected Applin .ces
Other Fixtures ---- Water Heater
--- Water Treating System
RE-PIPE:
TYPE OF FIXTURE Qry TYPE OF FIXTURE
Bathtub QTY
Clothes Washer —-- Septic Tank&Pit
Dishwasher Shower -
Drinking Fountain Shower Pan
Floor Drain Slop Sink
Floor Sink Three Compartment Sint
Hose Bibs Toilet
Kitchen Sink - Urinal
Laundry Tray Vacuum Breakers
Lavat — Water Connected Applia tees
Other F xtures -- Water Heater __
Water Treating System
MISCELLANEOUS:
o Sewer Replacement o Back Flow Preventer o Grease Interceptor(Trap) gall ens
(Requires 3 sets of plans)
o Lawn Sprinkler System-Number of Heads o Well **
**SIRWD Well Completion Form.Completed fo to be submitted to the Building D part' tent 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 rix ths.I hereby certify that I have read
this application and know the same to be true and correct, Mt provisions of laws and ordinances governing this we k will a complied with whether specified
or not. The permit does not give authority to violate the provisions of any other state or local taw regulation consir. ;tion t the performance of construction.
Property Owners Namet2t 't . - 1>c t, C-N I,ktO I I 0
pktiAtOf Phtn7e N mber��' �� j (.0Plumbing Company K-t in#t�a�( " Office Phoe 1el / •1 551 Fax—rifp. 7 a3 5
Co.Address:p 34 KA°4-14- /. 1 City t State Zip 3A?o S-
License Holder(Print): M e'►-t"-• F-; Yvt.loa "
State Certification Regi: tration#CR 017 311
4Vglai zerl_S1mmatri.P fit'tliww mower-
' 1��,,, JENNIFER KOSKI I eaLite______
;�� Notary Public-Stats of Florida Before me this '
'' „:q. My Comm expires Oct 27.2017 day Of -.�i _ I21
( .,',;.%+�.t1Commission a FF 035309 <1 /
''f 1i;,'n , Bonded Thrwgh Nat onal beta
Assn. gnature of Notary Public_ 7 ;k �r , U Lit
,,• ,
SSS` ATLANTIC BEACH
J;--_,Ni--,:- . yr PERMIT RECEIPT
v
%'-!Jail J'r January 3, 2017
PERMIT DESCRIPTION: PLUMBING - 1 SHOWER POAN
PERMIT NUMBER: 17-PLBG-2910
ADDRESS: 1528 W PARK TER
OWNER:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $7.00
Trade Permit Base Fee $55.00
Totals: $66.00
P PIC)
03101 PSH
SAN �P�.\\�gE