1535 Selva Marina Dr plbg permit CITY OF ATLANTIC BEACH
Y 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
)OB INFORMATION:
Job ID: 17-PLBG-3280
lob Type: PLUMBING ONLY
Description: install 20 fixtures
Estimated Value: $1,800.00
Issue Date: 2/16/2017
Expiration Date: 8/15/2017
PROPERTY ADDRESS:
Address: 1535 SELVA MARINA DR
RE Number: 171948-0000
PROPERTY OWNER:
Name: 1535 Selva Marina Drive LLC
Address: 501 Riverside AVE
GENERAL CONTRACTOR INFORMATION:
Name: CUSTOM PLUMBING AND TILE
,CFC1427389
Address: 2742 SETTLEMENT DR QA THOMAS MICHAEL
BLACKBURN
Phone: -
FEES:
Plumbing Fixtures $140.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $199.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845
JoB ADDRESS: 4535 sells O C PERmTr#
NEW OR REPLACEMENT INSTALLATION: Project Value$ SMC)
TFPE oFFr=RE QTY TYPE oFFLYTT/RE QTY
Bathtub a Septic Tank&Pit
Clothes Washer —7— Shower
Dishwasher —1--- 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 'off
Other Fixtures Water Treating System
RE-PIPE:
TFPEoFFLvvAE QTY TYPEOFFDXwBE 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
A1�S,ISCELLANEOUS:
Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well **
**SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ Other__ /IOCC 2 01,t f
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 mad
this application and know the same to be true and contact. All provisions of laws and ordinances governing this work will be complied with whether specified
ornot. The permit does not give authorityto violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name 15//3� 5 /.� [f/iet 11,20 t-. �2t C. Phone Number
Plumbing Comp��an}y��O� l YTI/I'1 //(�/4/ AIN 9��/P Office Phone '�$! Floc
Co.Address: /�N �2 SC47 e,r't.'�1�� -� 422 City ,�4 'Vi State 4 Zip-7Ze Z6
License Holder(Print): S Ac1CaUe�i- State Certification/Registration# 02cl(4?- 1
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Signature of Notary Publics -