1650 E Park Terr 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 NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-PLBG-3254
Job Type: PLUMBING ONLY
Description: water heater
Estimated Value:
Issue Date: 2/14/2017
Expiration Date: 8/13/2017 ,
PROPERTY ADDRESS:
Address: 1650 E PARK TER
RE Number: 172020-0308
PROPERTY OWNER:
Name: HOLLWARTH, DOROTHY C
Address: 1650 E PARK TER
GENERAL CONTRACTOR INFORMATION:
Name: DAVID GRAY PLUMBING INC.
David Fred Gray,CFCO22586
Address: 6491 S POWERS AVE QA DAVID FRED GRAY
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 ES 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
I(n50 211,x- ( 14—PERMIT - Sas I
Jos ADDRESS: lrf./y_ �/ri S�' PEMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPEoFFIXTURE QTY TYPEoFFfxTURE 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:
TYPEOFFixTURE 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 Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
C Sewer Replacement C Back Flow Preventer C Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
D Lawn Sprinkler System-Number of Heads ❑ Well **
**SIRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
C Other
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 bue 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 crony other state or local law regulation constmction or the performance of construction.
Property Owners Name ,060 'N .Y
1 'i4i Phone Number qNl(a�1 _qa•
PlumbingCompany� '"yyJ C I(.1,401r1a,lAC, OfficeePhoneg0+71*J'?Jl Fax9�- Z+5rg7S
Co. Address: (PLAT &JfrS AVIMUd, City_TC1CAV56nUl1lt State1�L Zip 32L11
License Holder(Print): -DqV1 a State Certification/Registration# c 2, (O
Notarized Signature of License Holder
Swom and subscribed before me this day of Y 20(a
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Signature of Nota Public rv,aaete g rY018