2190 S. Fairway Villas 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 NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-PLBG-3482
Job Type: PLUMBING ONLY
Description: install 5 fixtures
Estimated Value:
Issue Date: 3/14/2017
Expiration Date: 9/10/2017
PROPERTY ADDRESS:
Address: 2190 S FAIRWAY VILLAS LN
RE Number: 169398-1002
PROPERTY OWNER:
Name: Keane, David
Address: 2055 Beach AVE
GENERAL CONTRACTOR INFORMATION:
Name: Doug's Drains & More, Inc.
Douglas Matthew Parsons,CFC1425800
Address: 1198 MAYPORT RD UNIT 04 OL ONLY
Phone: 904-372-7727
FEES:
Plumbing Fixtures $70.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Work W/O Permit Plumbing $55.00
Total Payments: $184.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDBVANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-58226r Fax(904)2477-5845 P L�L� —3�B
JOB ADDRESS: ��e JB✓0 PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Values
TYPE oFFIXTURE 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 oFFixTURE 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
MISCELLANEOUS:
❑ Sewer 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.**
Other Ahkl ihf /� uu�� ✓1 eco oCcx�o�rr� /
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 true 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 my other slate or local law regulation construction or the performance of construction.
Property Owners Name94''�"/m r x'/o�' lee4,✓e Phone Number ZTl-/7Y�
Plumbing Company '1 Per lllr Office Phone 9sY 77L77Z7 Fax
Co. Address: O/9� /t��,Y/�"//� f'/� �� City State Zip
License Holder(Print): odf State Certification/Registration# C/4/9'ZS'1W
Notarized Signature1 INTIRE
;'a'm � Commission#
;, s ExpimB'eFa�l e„ u, ay of r 20
ignature of Notary Public