1067 Beach Ave plbg permit r$111PIlyr,
CITY OF ATLANTIC BEACH
j 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: 17-PLBG-2974
Job Type: PLUMBING ONLY
Description: install 12 fixtures
Estimated Value: $13,685.00
issue Date: 1/10/2017
Expiration Date: 7/9/2017
PROPERTY ADDRESS:
Address: 1067 BEACH AVE
RE Number: 170267-0000
PROPERTY OWNER:
Name: MANDARIN EMPORIUM INC
Address: 2240 Mayport RD #7
GENERAL CONTRACTOR INFORMATION:
Name: STYLES SMITH PLUMBING, INC
,CFC041803
Address: 1537 PENMAN RD SUITE A OA DARRELL GLEN SMITH
Phone: - -
FEES:
Plumbing Fixtures $84.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $143.00
PERMIT IS APPROVED ONLY W ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
r�
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845
FOB ADDRESS: )6b? R e,&&ii Av P_ PERMIT#
VEW RREPLACEMENTINSTALLATION: Project Value$ 1to 015- Go
TYPEOFFIRTURE QTY TYPE OF FIXTURE QTY
Bathtub r2 Septic Tank&Pit
Clothes Washer _L Shower
Dishwasher �_ Shower Pan
Drinking Fountain Slop Sink
Floor Dram Three Compartment Sink
Floor Sink Toilet
Hose Bibs d Urinal
Kitchen Sink �_ Vacuum Breakers
Laura T Water Connected Appliances
Lavatory T Water Heater
Other Fixtures Water Treating System
RE-PIPE:
TYPE OF FIXTURE QTY TYPEOFFIXPURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking nain SI Sink
Floor
TTCom
partment 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:
n Sewer Replacement ❑Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of pleas)
❑ Lawn Sprinkler System-Number of Heads ❑ Well ••
**SIRWD Well Completion Form.Comple f[ermto 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 ste mondts.i hereby cml*that I haveread
this application and know the same to be true and corn a All provisions of laws and ordinances governing this work will be complied with whether specified
or not The pwmit does not give authority to violate the provisions of my other state or local law regulation construction orthe performance of construction.
o!' h
Property Owners Name L1,.r,-S )-}i bra� d e 5 r�/Moodltn 'M� Phone Number
Plumbing Company ';+v )B S ';ry e N, PIy^ h'�n'Office Phone d H I - N/3/ Fax
Co. Address: ) 9-3 7 PP n M aA rd. city .Tax R ace 1. State fLZip 32,Z S0
License Holder(Print): '-'yI P S SM + }LC State Certification/Registration# I H 2 K(o%2
Notarized Signature o Luense olderNump
g JBJNIFER JOHNSWN Sworn and subscribed before me this lbw ay of n d f i 20_
fol
W COMMISSION N GG a138a5 f
E%MES'.Gcbaer P.203 � ^ I
f, e•Nw,,,,,,xony,,,emu�.r«nl.. SigaatlueofNotaryPublicJ