1722 Maritime Oak Dr plbg permit CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-2735
Job Type: PLUMBING ONLY
Description: install 23 fixtures
Estimated Value:
Issue Date: 12/8/2016
Expiration Date: 6/6/2017
PROPERTY ADDRESS:
Address: 1722 MARITIME OAK DR
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: NELSON PLUMBING CO. INC.
Scott Nelson,CFCO20379
Address: 11624 -1 DAV E DAVIS CREEK RD CIA SCOTT GARY
NELSON
Phone: -
FEES:
Plumbing Fixtures $161.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $220.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION 0
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904)247-5845 110_PL-8&a _x-t35
dOBADDRESS: 1'122 IMMU11ME 06lt- Qd_ PERMrr# 16- SF¢-21zo
NEW OR REPLACEMENT INSTALLATION: Project Value s
TYPE of FIXTURE QTY TYPE oFFrXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan I
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
LavatoryWater Heater
Other nures Water Treating System
RE-PIPE:
TYPE oFFIXTURE 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
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 tomato 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 my other state or local law regulation contraction or the performance of construction.
Property Owners Name Phone Number
Plumbing Company, /IIF1SrtW ?1 uwtr is t6 Lo Z-wL Office Phone 262• VS94Fa,
Co. Address: Milt- , 4 City state-,R—zip 32LS
License Holder(Print): N S ;ef
faon/Registration# 7 20
Notarized Signature o License older
)) I / �
'ay; Imkr' eorcuz Before me this day of
arwk�9ssa t 20(0
Exp'm:llwMnEar 16.9919
> 9ar*kriwnuvwaeUtl�.aw• Signature of Notary Publ' !/ZZk