807 Camelia St plbg permit . ?SIyLJr�rl
CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOBINFORMATION:
Job ID: 17-PLBG-3232
Job Type: PLUMBING ONLY
Description: install water heater
Estimated Value: $775.00
Issue Date: 2/10/2017
Expiration Date: 8/9/2017
PROPERTY ADDRESS:
Address: 807 CAMELIA ST
RE Number: 170937-0000
PROPERTY OWNER:
Name: PEACOCK, JOHN E
Address: 874 N 5TH ST
GENERAL CONTRACTOR INFORMATION:
Name: BROWARD FACTORY SERVICE BFS
Jerry Leroy Brightwell,CFC056667
Address: 2071 EMERSON ST CIA JERRY LEROY BRIGHTWELL
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Plumbing Fixtures $7.00
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
Q �] /1
Ph(904) 247-5826 1 ( Fax(904)247-5845
JOB ADDRESS: !l0 1 (ia�1�Q,1 I �Tf e 2� PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value S I "
TYPE of FixTURE 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 of FIXTURE QTY TYPE of FIXTURE 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 Tiny 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 **
**&IRWD 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.1 hereby certify that I have read
this application and know the same to be tme and coned 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 ofconstmction.
Property Owners Name 00hN {�23lLC0C-k Phone Number 404DU73B4'7
Plumbing Companypirnutrar� Beryi( e. Office phonegc4-3¢VW �5- Fax 3 (,Y-8S0
Co.Address:9071 Gm erson 64"'16 Cityac ky,yi I I-e State f ZipG7
License Holder(Print):7kerro Lefou gf' tate ficat ' tration#CFCaf5(Ak7
Notarized Signature of License Holder
Sworn d sub cribed be e t is da o^ AA 201�7
Signature 11 7 A
EXPIRES Fa ry 14.7020
Cpl M . . rM