855 Sailfish Dr plbg permit 11
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-3591
Job Type: PLUMBING ONLY
Description: install 9 fixtures
Estimated Value:
Issue Date: 3/27/2017
Expiration Date: 9/23/2017
PROPERTY ADDRESS:
Address: 855 SAILFISH DR
RE Number: 171246-0000
PROPERTY OWNER:
Name: Dominant Assets LLC
Address: 1148 B Fruit Cove Road ST
GENERAL CONTRACTOR INFORMATION:
Name: C W WOOD PLUMBING
Wallace Scott Wood,CFC057097
Address: 1328 ROMNEY ST QA WALLACE SCOTT WOOD
Phone: -
FEES:
Plumbing Fixtures $63.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $122.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Faxx (904) 247-5845
Jos ADDRESS: �SS ��• /^,s`� , �_ PERMTT# 53
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE oFFTXTURE QTY TYPE of FIXTURE QTY
Bathtub l Septic Tank&Pit
Clothes Washer / Shower —
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Dram "Three Compartment Sink
Floor Sink Toilet �—
Hose Bibs Urinal
Kitchen Sink t Vacuum Breakers
Laundry Tray Water Corrected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
RE-PIPE:
TYPE of F/XTURE QTY TYPE oFFLYTURE 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 SinkVacuum 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 '#
**SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ 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 cen fy that I We rend
this application and know the snore to be we and cortx[. All previsions of laws and ordinances governing this work will be complied with whether specified
or not. The price does not give authority to violate the provisions of any other a or local l v JpgulatimcoMndaiSn or the performance of construction.
Property Owners Name/ g?ink &, e,-1 !�/r(/feMY'-+Phone Number
Plumbing Company C.--WDZ y_ly~` L'f Office Phone /Y�"'W YFax
0p,12C 7 city Tx State h�zip u
co. Aaareaa: 13W 60,4912C�I
License Holder(Print):
7 tate atio egl tion#�fGr .fi�97
J CV rlNy�
Notarized Signature o Dicense Holder
n'xv"r"fiy MY CO MI SSN)NXon o�i2esa Before me this a�{� day oftenn t-� 20-Y"r°i E%PIPFS.OMber2l,Ata -y
.,,gn;vy: arra,an,,,aoav vsucww„ni,a Signature of Notary Public nr