788 Vecuna Dr plbg permit CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
D
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
]OB INFORMATION:
Job ID: 17-PLBG-3052
Job Type: PLUMBING ONLY
Description: install clothes washer
Estimated Value:
Issue Date: 1/19/2017
Expiration Date: 7/18/2017
PROPERTY ADDRESS:
Address: 788 VECUNA RD
RE Number: 171352-0000
PROPERTY OWNER:
Name: STRANDHAGEN, JENO
Address: 788 VECUN RD
GENERAL CONTRACTOR INFORMATION:
Name: KELLOW'S RAPID RESPONSE
Robert Eugene Kellow,CFC1426875
Address: QA ROBERT EUGENE KELLOW QA ROBERT EUGENE
KELLOW
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 Beack FL 32233
Ph(904)247-5826 Fax(904)247-5845 }-P LBC-3
JOB ADDRESS: t"c` 4 k'D. +-rt IfCW �C �zz3�ERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value s
TYPE OF FIXTURE QTY T}PEOFFVavRE QTY .
Bathtub Septic Teak&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:
TYPEOFFLrFURE QTY TYPE OFF&wRE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher - Shower Pan
Drinking Fountain Slop Sink '
Floor Drain Three Compartment Sink —
Floor Side Toilet —
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement 0 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 doss not commence within a six month period or work is suVeaded or abandoned for six montim I hereby certify that I have read
thus application and know the same to be hue and const. All provisions of laws and ordinances govemingthis 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 econcoction or the performance of construction.
Property Owners Name JF'I-b 57_R.4*e JGf/4EYr/ Phone Number73r/- 716 -3927
Kt ceawJ reAVIP reespv3EFax X61-27y'2
Plumbing Company P7 u Me t w G OfficePhone 9os'-1y7-6S3�
Co.Address: 62S ow6aJ 4v,- Serrrf 629 City taeks mak State,Pz�( Zip322t7
License Holder(Print): State Certification/Registration#C4k�9 O975'
N re o License Holder
, y'm:fyf"s. PATRICIA q.HENRY
Commisaba a PP 083273 Before me this day of 20�_
,'f, P�pnesmers,zota Signature of Notary Public
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