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939 Amberjack Ln plbg permit CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 INSPECTION PHONE LINE 247-5814 PLUMBING PERMIT MUST CALL BY 4PM FOR NEItT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 17-PLBG-3390 Job Type: PLUMBING ONLY Description: Estimated Value: Issue Date: 3/1/2017 Expiration Date: 8/2812017 PROPERTY ADDRESS: Address: 939 AMBERJACK LN RE Number: 171175-0000 PROPERTY OWNER: Name: HAMPTON ET AL, MARY E Address: 939 AMBERJACK LN GENERAL CONTRACTOR INFORMATION: Name: ROTO ROOTER SERVICES ,CFC 057629 Address: 2028 W 21ST ST CIA ROBERT VINCENT FARR Phone: - FEES: State PLMG DBPR Surcharge $2.00 State PLMG DCA Surcharge $2.00 Plumbing Fixtures $7.00 Trade Permit Base Fee $55.00 Total Payments: $66.00 PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CIT' OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA BUILDING CODES. PLUMBING PERMIT APPLICATION CITY OF ATLANTIC BEACH 800 Seminole Rd Atlantic Beach, FL 32233 Ph(904)247-5826 Fax(904)247-5845 JOB ADDRESS: 5 t7�`t��G( j'AC/�'' L-tj PERMIT # NEW OR REPLACEMENT INSTALLATION: Project Value$ TYPE oFF/XTURE QTY TYPE oFFIXTURE 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 OFF/XTURE QTY TYPEoFF/XTURE 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: t Acwer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans) ❑ Lawn Sprinkler System-Number of Heads ❑ Well ** ** SIRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.** El Other e— 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 me 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 any other state or local law regulation construction or the performance of construction. Property Owners Name V'l\x61[y Lw\ !QCk'ku w� Phone Number Plumbing Company kA )\L(A ) �'r-C Office Phone �U 6 6 y)l YI2 Fax Co.Address: 212 C3 'LI )t— -SlRy FL City State ReZip 2Lr- License Holder(Print): 0-IMC. 0C U e U tate CertificatiQn/Begistmtion# f N Cyo& f Notarized Signature of License Holder ✓a,do^ G(dV ec-- ^ 2 Before me this day of 20 ��Y Signature of Notary Public 03-01-17;02:OOPM; , V "!! V PLUMBING PERMIT APPLICATION m CITY OF ATLANTIC BEACH 800 Seminole ltd Atlantic Beach,FL 32233 Ph(904)247-5826 Fax(904)247.5845 17- P LC-,C,- 3--�,c�d JOBADDRESS: 3-5 Ank-' &Gk Ln g4 �cc ,gct1 ( 3aa33PEIthIIz# NEW OR REPLACEMMiNSTALLAnON: Project Value$ TYP.50rFuwRE QTY TyProrFnrunE QTF Bathtub Septic Tank&Pit Clothes Washer Shower Dishwasher Shower Fan — Drinking Fountain Slop Sink Floor Drain Throe Compartment Sink Floor Sink Toilet '—` Nose Bibs it — Kitchen Sink UrinalVacuum Tray Water Connected Appliances Lavatory Waterlleater — Other Fixtures Water Treating System RE-PIPE: TYF6or•FIATURE QTr TxpEOFFr=AE gry Bathtub — Septic Tank&Pit Clothes WasherShower '-- Dishwasher — Shower Pan — Drinking Fountain Slop Sink — Floor Sink Three Compartment Sink — Hosecar Sink — Toilet Hose Bibs -- Urinal Kitchen Sink Vacuum Breakers Laundry Tray Water Connectod Appliances Lavatory — Other Fixtures Water Treter ating System NVSCELLANEOUS: 3d Sewer Replacement ❑Back Flow Preventer ❑ Grease Interceptor(Trap)—gallons(Requires 3 sets of plans) o Lawn Sprinkler System-Number of Pleads ❑ Well ** **SJRWD Well Completion Form. Comple £te�orm to be submitted to t e u dmg Department for final inspection,** ❑ Other Pcwmit beeomes void if work does not oommenoo within n six month pciod or work is suspended or abandoned forsix mendm t hemby eatdfy thee f have rtod this epplicetion end know the same to be ova and cormet. All provisions of laws and ordinances governing this work will be aomplied with wlurhu specified or not The patmlt does not give Authority to violate the provisions of my other salts or lean)kw regulation construction or the porformanoe of caftsmictionn, Property OwnersNamol=QN Lomb s4o✓K Phone Number q4q .307" a1Jq Plumbing Company ;eV40oof�r Office Phone Qat 35'f 73zt Fax goW i35y 9i Co.Address: oZg AIW4- Z J- S{r�e� 7Zt Cityy State k zii g-9-01 License Holder(Print): /�Ot r b on� State Cerkification/Registration ll CFC, D•5l(oo2t NotarizedSignatureofLicorareHoldeh. 12....- 1/ ^4 ----N - •. Before me this d f N 20 ComMaslm#FF IAb Signature of No �•i ExploNeremberra,za,.; � taryPublic e...m.nwr.nnwn.aea..;.