1758 Maritime Oak Dr plbg permit -S'
" r CITY OF ATLANTIC BEACH
r 800 SEMINOLE ROAD
j ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
'r�JiiJ�
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-PLBG-2973
Job Type: PLUMBING ONLY
Description: PLUMBING -21 FIXTURES
Estimated Value:
Issue Date: 1/10/2017
Expiration Date: 7/9/2017
PROPERTY ADDRESS:
Address: 1758 MARITIME OAK DR
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: DARLEYS PLUMBING INC.
,CFC056702
Address: 4472 PHILLIPS HWY CIA CARL LESLIE DARLEY
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $147.00
Trade Permit Base Fee $55.00
Total Payments: $206.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CUFF OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845 17_ p L gG_z9 73
JOB ADDRESS: I 1 AAML T7' - 04K J&- PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE of FTXTuRE QTY TYPE oFFLmRE QTY
Bathtub Z Septic Tank&Pit
Clothes Washer _ Shower Z
Dishwasher .J— Shower Pan
Drinking Fountain Slop Sink
Floor Drain Tbree Compartment Sink
Floor Sink Toilet
Hose Bibs ¢ Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances 7-
Lavatoryater Heater T
Other Fixtures Water Treating System I
RE-PIPE: DW
TYPE of FIXTURE QTY TYPE oFFTXTORE 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 ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well *'
**SJRWD 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 slate or local law regulation construction or the performance of construction.
PropertyOwners Name T occ- X-5 Phone Number
Plumbing Company bgLF-4 j A-rx, -%.r Office Phone -71-1-09Y Fax 727-1 Y8�
Co. Address: YY7L haGrrt #-,,if City 7ft Stater� Zip
License Holder(Print): LState Certification/Registration# CA-' 03'6702
Notarized Signature oJLicense Halder
AA Nt MEHL � Sworn and subscribed before t �s day of�.W�ta). 20�
My L minssion#a GG9 FI*nde
"•••.,
t, Nana PaMle-Stated
ire, = znet Signature of Notary Public
y ,�% 29 2020