1977 Seminole Rd plbg permit i-f lr'�+IlrJn .
?; CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
X 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-3120
Job Type: PLUMBING ONLY
Description: PLUMBING - 11 FIXTURES
Estimated Value:
Issue Date: 1/27/2017
Expiration Date: 7/26/2017
PROPERTY ADDRESS:
Address: 1977 SEMINOLE RD
RE Number: 169542-0502
GENERAL CONTRACTOR INFORMATION:
Name: NELSON PLUMBING CO. INC.
Scott Nelson,CFCO20379
Address: 11624 -1 DAVE DAVIS CREEK RD QA SCOTT GARY
NELSON
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $77.00
Trade Permit Base Fee $55.00
Total Payments: $136.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5945 I `J_
JOB ADDRESS: I q 1 7 �ge A1'i rt/9 Le Vo PERMIT# I7- 9APa- 0
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPEOFFVcrvRE QTY TYPEOFFDMIRE QTY
Bathtub I =Tank&Pit
Clothes Washer S1roWer
Dishwaslw - Shower Pan
Drinl®g Fotmtam Slop Sink
Floor Dram Thtee Compmuneni Sink
Floor Sink - Toilet
Hose Bibs Urinal
Kitchen Sink = Vacoom Breakers
Laundry Tray Water Connected Appliances
.Lavatory Water Heater
Otlua Fzxtums \\ Water Treating System
RE-PIPE:
TYPEOFF)XTu,RE QTY TYPEOFFn3vEE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shove —
Dishwasher SBower Pan
Drinking lop Sink
FlDrain ntmtam SThree Compartment
Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Lannat},Tray Water Connected Appliances
Lavatory Water Heater _
OtherFixtures Water Treating System MISCELLANEOUS:
O Sewer Replacement ❑Back Flow Preveoter ❑ Grease Interceptor(Trap)—gallons(Re aaraa 3 am of peer
G Lawn Sptivkler System-Number of Heads ❑ Well
VRwD Well Completion Form.Completed be sobmittedto I — Department for Baal speenor
❑ Other
Permit 6ernmes void ifworkdoes not wmmmce wahm serx month period or woh u suspended or abeodmed for z..d,I hereby--*Vat 1 have
1h1q,plic3ti®mdlvoWthe—Wbenaeaadamee Allprowam oflam and onl a4ovaamatltis we&win be complied with whether spell
err am The petmitdm amgve amhority to viohde tboproviswl�a ofaoy oth""O mloW law wgulaim wvsm4etim ormeped'cemmee of mast[acdc
PropertyOtvaersName DCNNIc wi VyVLMAr-� Phone Number
Plumbing Company O.J u.t N Office Phone 262-Y H S t(Fax
Co.Address: HUS -1 VOW, Ct9 E ity Smiel-L Zip SAY
License Holder(Print): AlN cation/Registration#-'01P 31 i-
Notarized Sknarure of Liceme Holder
+ wip.Rm Sworn and subscri ore KtAR 2of7
.€,a�y MYIX:N 111=1 FF7A342 i
,+j--.�+f E%PIRES'.Nwembwu. 2o19 S' of Notary Public