1781 Atlantic Beach Dr plbg permit S yL�r
CITY OF ATLANTIC BEACH
y. j 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
A�JPl9'"
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
30B INFORMATION:
Sob ID: 17-PLBG-3499
Sob Type: PLUMBING ONLY
Description: install 31 fixtures
Estimated Value:
Issue Date: 3/16/2017
Expiration Date: 9/12/2017
PROPERTY ADDRESS:
Address: 1781 ATLANTIC BEACH DR
RE Number: None
PROPERTY OWNER:
Name: RIVERSIDE HOMES OF N FL
Address: 414 OLD HARD RD STE 502 MATTHEW ROBERTS
GENERAL CONTRACTOR INFORMATION:
Name: NELSON PLUMBING CO. INC.
Scott Nelson,CFCO20379
Address: 11624 -1 DAVE DAVIS CREEK RD QA SCOTT GARY
NELSON
Phone: -
FEES:
Plumbing Fixtures $217.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $276.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845 't- P(..6Ca-3 L145
aoBADDREgs: I18I ATlAmir ge&u Dg. P>R M rr# n-sFe-3M
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPEOFFDanRE QTY TYPEOFFwvRE QTY
Bathtub _I__ Septic Tank&Pit
Clothes Washer _I_ Shower
Dishwasher Shower Pan
Drinking Foimtam Slop Sink
Drain ain Three Compartment Sink
Floor Side - Toilet
Hose Bibs Urinal
Kitchen Vacuum BreakeI
Laundry T y Water Connected Appliances
Lavatory Water Heater
Other Ftxnaes Water Treating System
RE-PIPE:
TYPEOFFDavRE QTY TYFEOFFDTURE QTY
Badrmb Septic Talc&Pit
Clothes Washy Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Dram Thee Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Waumr Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
O Sewer Replacement o Back Flow Preventer o Grease Interceptor(Imp)_gallons(Bequaes 3 sets of pb
o Lawn Sprinkler System-Number of Heads o Well **
**SIRWD WeU Completion Form.Completed form to be submitted to the Bm1�mg Department for final mspwior
o Other
Permit becomes void ifworkdaes not onemmrr warm asbcmouth paiodw work u srspemiei orabaodmed form moatim I hereby certify that I have
thuapplia =dkoowthe� Wbetrtmavdemrax. All provimoos of laws and ardmaeees guvanmgthw we&will be con Phed with whether Wert
a wL Theparafti mgvoatah(o7ri`rymviohte the provis;'wls afany other area or load lawregolarm,wamuaiov or the performance ofwastroctic
Property Owners Name�VFIZS10E- tt0YY1l;S Phone Number
Plumbing Company /1NF/SPN &NMRING & Ta.IC Office Phone 9"7—YMYFax
Co.Address: YI S 0 c State_6_Zip&=
License Holder(Print)). CerrificationMegistration# 07,03 7
3 couuissrorrlitx"soa� °fir .
(; EXPIRES:HwamW 16.2019 cJ day of
f: mmw,nNwwvswrum.nm. Swum and su beforeme v a
Signature of Notary Publi