185 Sherry Dr plbg permit sl
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
+I 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-3569
Job Type: PLUMBING ONLY
Description: PLUMBING - 2 FIXTURES
Estimated Value:
Issue Date: 3/24/2017
Expiration Date: 9/20/2017 _
PROPERTY ADDRESS:
Address: 185 SHERRY DR
RE Number: 169798-0000
PROPERTY OWNER:
Name: SILVIUS, RICHARD P
Address: 185 SHERRY DR
GENERAL CONTRACTOR INFORMATION:
Name: WILLIAM'S BIG BOY PLUMBING INC
, RF0066703
Address: 516 SOUTH 11TH AVE QA WILLIAM WAGNER
GOODLING
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $14.00
Trade Permit Base Fee $55.00
Total Payments: $73.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904) 247-5845 17 -PL 3S
JOB ADDRESS: S I le f f r PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE oFFIXTURE QTY TYPE oFF7XTORE 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 1 Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
RE-PIPE: /il
TYPE of FIXTURE QTY !� TYPEOFFIxTORE 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
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 we 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 any other state or local law regulation construction or the performance of construction.
Property Owners Name Phone Number
Pltunbing Company (ArIIf-44 0-k P,(4 Go Office Phone R`1 I-1 1�0 Fax
Co. Address: 6-f(P If i 1 S - C ity 3�. State F Zips 2�0
License Holder(Print): (,J t11ik GocpUu, State Certification/Registration# $(a1r.10763
Notarized Signature ofLicense Holder -
Before me this_Z_16day o 20_
mMaMOLESPEaGEa
NYCOM'aSSIO:IYFFBYg951 Signature of Notary Public12
EXPIRES:October 6,2018
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