806 Cavalla Rd plbg permit S` CITY OF ATLANTIC BEACH
o
r 800 SEMINOLE 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-2889
Job Type: PLUMBING ONLY
Description: PLUMBING -9 FIXTURES
Estimated Value:
Issue Date: 12/29/2016
Expiration Date: 6/27/2017
PROPERTY ADDRESS:
Address: 806 CAVALLA RD
RE Number: 171717-0050
PROPERTY OWNER:
Name: WILBURTH, JOHN
Address: 13825 BELLE RIVA LN
GENERAL CONTRACTOR INFORMATION:
Name: D W V PLUMBING INC
D W V PLUMBING INC DAVID VERS$CFC1428211
Address: 4705 Cedar Point RD
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $63.00
Trade Permit Base Fee $55.00
Total Payments: $122.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beacb,FL 32233 / Q
Ph(904)247-5826 Fax(904)247-5845
JoB ADDREss: `164i CaV0.(1g Rvv J &A-I . DkAr kr Flt . 3 t W. P PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPEOFFmuRE QTY TYPE oFFLYTURE QTY
BathtubSeptic 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:
TYPEOFFIXTURE .QTY T)rPEOFFIXTURE QTY
Bathtub F Septic Tank&Pit
Clothes Washer _(_ Shower
Dishwasher �_ Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartrnent Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 7- 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 •'
**STRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
C3 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 m be true end 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 constmction or the performance of construction.
Property Owners Name 3666 W i I I{V7 Vl' N Phone Number 71 3 - 47 T-3
Plumbing Company WV Rucuh;4 Q\C - Office Phone'111-7671b Fax
Co.Address:147 CLA sr PC"t 6 - City SPX State Zip'Bil.116
License Holder(Print): T6V i J W . U tate Certification/Registration# t\U/ LI I
Notarized Signature o older t �
•"- aotESPEacEa Before me this �� da o 20
. ji � Wy{ ISS�nNOFF 9X951
EXPIRES'.pdoper 6,2919
.'� e,a.er6m wwv>'°�`°n°""'s" Sig[tature of Notary Public