1640 BEACH AVE - PLUMBING �' '' . s, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
N----- _-01-1191.
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-PLBG-3704
Job Type: PLUMBING ONLY
Description: install water heater
Estimated Value:
Issue Date: 4/7/2017
Expiration Date: 10/4/2017
PROPERTY ADDRESS:
Address: 1640 BEACH AVE
RE Number: 169540-0010
PROPERTY OWNER:
Name: PLATOCK, BRIAN T & LESLIE G, *
Address: 1640 BEACH AVE
GENERAL CONTRACTOR INFORMATION:
Name: DAVID GRAY PLUMBING INC.
David Fred Gray, CFCO22586
Address: 6491 S POWERS AVE QA DAVID FRED GRAY
Phone: - -
FEES:
Plumbing Fixtures $7.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $66.00
FERMI IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-58266 Fax (904) 247-5845 l PL`�(�l_3 �(
JOB ADDRESS: I 1140 B1 U,(, PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE 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 OF FIXTURE QTY TYPE OF FIXTURE 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 o Back Flow Preventer ❑ Grease Interceptor (Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads o Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
o 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 true and correct. All provisions of laws and ordinances governing this work will he 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 (.ebhc, Phone Number CI Oil"Aq -. 35sg
Plumbing Company-11.1)j 0rati(L ldJ i rq I/1G Office hone�oq-7Zi 41.11 Fax t1 - L5
Co. Address: C{ 90w�5 rte. J City jacAt. ►1r)?t State i'L Zip 5d-€vi
lv`� 1 ,
License Holder(Print): Vlnlv/o to Certification/Registration#Lek/422.9.49
Notarized Signature of License Holder •
II
gerNotary Public State of Florida Sworn and subscribed before me this day of A ( 20 1
. Wendy Rayle
�f My Commission FF 133678 Signature of Notary Public
->ocpo Expires 06/17/2018