859 Ocean Blvd plbg permit ?, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
�r ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
IOBINFORMATION:
Job ID: 17-PLBG-2913
lob Type: PLUMBING ONLY
Description: PLUMBING - 2 FIXTURES
Estimated Value:
Issue Date: 1/4/2017
Expiration Date: 7/3/2017
PROPERTY ADDRESS:
Address: 859 OCEAN BLVD
RE Number: 170246-0010
PROPERTY OWNER:
Name: MURPHY, ALISON J & ROBERT, `
Address: 859 OCEAN BLVD
GENERAL CONTRACTOR INFORMATION:
Name: WAYNE CONN PLUMBING INC.
Vernon J.Sparks,CFC1428564
Address: 6915 W BEAVER ST
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $14.00
Trade Permit Base Fee $55.00
Total Payments: $73.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax (904)247-5845
` f(o-P�
JOB ADDRESS: �SS OGPA/II � PERMIT# _Z9
NEW OR REPLACEMENT INSTALLATION: Project Value$ I&V
TYPE oFFfxTURE 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
RE-PIPE:
TYPE oFFixTURE QTY TYPE OFFLYwRE 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:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Crease Interceptor(Tmp) 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.**
❑ 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 Mdri^0r Phone Number
Plumbing Company ` — -04 f/weAiOffice Phonc ZS3 O�< Fax
Co. Address: 1,&L kJ .— '?� City Staff—/ zip Zip g2a y
License Holder(Print): C.r✓ r�/�f/iZ State Certification/Registration#
Notarized Signature ojLicense Holder
ff?MSE KkR= Before me this day o 20 .
MYCOM.tW01101`190512 Si natureofNo Pohl' P
* * E%PRES:May 15.2519 g
"rana� Bor4N11ru B+rOn NeY75mta �