411 Whiting Ln 17-PLBG-3252 plbg permit 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
JOB INFORMATION:
Job ID: 17-PLBG-3252
lob Type: PLUMBING ONLY
Description: sewer replacement
Estimated Value: $1,500.00
Issue Date: 2/14/2017
Expiration Date: 8/13/2017
PROPERTY ADDRESS:
Address: 411 WHITING LN
RE Number: 171442-0000
PROPERTY OWNER:
Name: JONES, ROSIE L
Address: 411 WHITING LN
GENERAL CONTRACTOR INFORMATION:
Name: TERRY VEREEN PLUMBING
,CFCO25597
Address: 2934 POST ST QA TERRY LEE VEREEN
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 Beach,FL 32233
(� 'Ph(904)247-5826 Fax(904)247-5845
JOB ADDRESS:_ / I ' o PERMIT# 3asa
PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value 8 oIZ)
TYPE OFFamRE QTY TYPEOFFIXTURE Q
Bathtub TY
Clothes Washer Septic Tank&Pit
Dishwasher Shower
Drinking Fountain Shower Pan
Floor Drain -- Slop
Floor Sink Three SiCnok
mpartment Sink --
Hose Bibs Toilet
Kitchen Sink -- Urinal
Laundry Tray Vacuum Breakers
yavato --- Water Connected Appliances
Other Futures Water Heater
Water Treating System
RE-PIPE:
TYPE OFFDTURE QTY TYPE OFFIXTORE
QTY
Bathtub Septic Tank&Pit
Clothes Washer -- Shower —
Dishwasher Shower Pan —
Fluorng Fountain
FSlop Sink
Floor Drain Compartment Sink
Floor Sink P
KitcHoshen
Urinal —
Bibs Toilet Three Com —
Kitchen Sink Vacuum Breakers —
Laundry Tray Water Connected Appliances —
Other Fixtures Water Heater
Water Treating System —
1SCELLANEOUS:
Sewer Replacement ❑Back Flow Preventer ❑ Grease Interceptor(Trap)_
gallons(Requires 3 sets of plans)
O Lawn Sprinkler System-Number of Heads 0 Well +*
**SIRWD Well Completion Form. Completed form to be submitted to the—BOTd—ing Department for final inspection.*
❑ Other
Permit becomes void if work dna not commence within a six month period or work is suspended or abandoned for six months.l h
this application and knew ate seine m be true and correct All provisions of laws and ordinances goveming this work will h complied with whethercertify that specifiedor not. The permit does not give a�ad/n ityto violate the provisions ofany otherstate or local law regulation mnwells ill be
ofthersudion.
Property Owners Na mTe_1`�a $I .e- ��n O 3 Phone Number oP-y6 - 7a 16
Plumbing Company. 1 -Q.( ` \r Ve C.!,i n IPE!C:42 OfficePhom 36q S 51 Fax 3 UjZV U
Co.Address: b 11 S _ City J- A.Y V,-Stote 1aL zip 32!aa/
License Holder(Print): -C State Certification/Registration#
Notarized Signature of License Ho/�e
TIFFANY 4x—iSw mend subscribed before me this_�3t" day ofuar�-I 20�
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COMMISSIONS FFISS569 /1
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EXPIRES 10114/2018 Signature of Notary Public 'A Q,t�tA 1
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