2021 Selva Madera Ct plbg permit (2) CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
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INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-PLBG-3098
Job Type: PLUMBING ONLY
Description: install dishwasher& sink
Estimated Value:
Issue Date: 1/25/2017
Expiration Date: 7/24/2017
PROPERTY ADDRESS:
Address: 2021 SELVA MADERA CT
RE Number: 169506-1650
PROPERTY OWNER:
Name: BURBRIDGE, H CLINTON
Address: 2021 SELVA MADERA CT
GENERAL CONTRACTOR INFORMATION:
Name: COUF PLUMBING LARRY COUF
Larry Couf,CFC1429147
Address: 1104 Wood Hill PL
Phone: -
FEES:
Plumbing Fixtures $14.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $73.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845
JOB ADDRESS: SY(. M°rdzr4 C+ PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPEOFFIXTORE QTY TYPEOFF)XMRE 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
RE-PIPE:
TYPE OFFIXTORE QTY TrrEOFF)XTORE 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 Cl Back Flow Preventer ❑ Orease 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.**
Cl Other
Permit becomes void if work does at commence within a six month period or work is suspended or abandoned for six mond s.I hereby certify that I have read
this application and knowthe same to be true and correct. All provisions of laws and ordinances gowning this work will be complied with whetber specified
or not. The permit does not give authority to violate the provisions of any other state m local law regulation construction or the performance of construction.
Property Owners NameCr�//'� 11Crbr'�� Phone Number
Plumbing Company e � Office Phone Fax
Co.Address: 116/Ll City 'J° x State Ft Zip 3Pv"s6
License Holder(Print): Gd State Cerdfication/Registration# EFe'tyRS1V7
rted,5*4aal2Nmen Holder
iY * MY eeMMISaION*GG aa29aa � " �
r rxvlaas:ormnazr.zozs Before me tbisaY of �csit�s;�L 20
'\tic'' eoM.a mNNotiry v�rWum.r�.
Signature of Notary Public ,J� )