925 Seminole Rd plbg permit S1 :
> , CITY OF ATLANTIC BEACH
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-3051
Job Type: PLUMBING ONLY
Description: install shower
Estimated Value: $500.00
Issue Date: 1/19/2017
Expiration Date: 7/18/2017
PROPERTY ADDRESS:
Address: 925 SEMINOLE RD
RE Number: 170060-0000
PROPERTY OWNER:
Name: ROSS, XAVIER &JILL, '
Address:
GENERAL CONTRACTOR INFORMATION:
Name: Mandarin Plumbing Inc.
Steven C.Siegler,CFC1428316
Address: 3737 Indian Princess RD
Phone: -
FEES:
Plumbing Fixtures $7.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 F/ax(904)10247-5845
JOB ADDRESS: `1 a J ✓ 2 �n 1 "1 0 4-e P� Cl PERNxr#
NEW OR REPLACEMENT INSTALLATION: Project Value$ S�(7
TYPE oFFUmRE QTY TYPEOFFIXTuRE QTY
Bathtub Septic Tank&Pit Z
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 oFFDaVRE QTY TIPEoFFIXTORE 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 tme and correct. All provisions of laws and ordinances governing this work will be complied with whether spmifi d
or not, -the permit does not give authority to violate the provisions of my other state or local law regulation constriction orthe pertfoormarim of construction.
Property Owners Name 't a L�a{ X 0.w P r OSS Phone Nu1?mber 3 1 _ 8; 'Z 2 3'
Plumbing Companyv%%nA�at�p �� �, i,t Office Phone $10"u�, 11 Fax
Co.Address: 37-3 7 �L c� ye &' I nCP i5 Q City 'Sn Y— State RG Zip 321 S
License Holder(Print): 41PVF 6 1 eq I Q f StateCert fiicatio dRegistra n# 1 �+ 3 (t/0
.. ao r, r older
.�'• � MY CAMMISSIG0 GG W29G ,y
URRES:amw2r,2o2o Before methis lel day of 20�
�? o,'.:' amtleaTM+NOMry wGcnaarman
Signature of Notary Public ---