1476 LAUREL WAY - PLUMBING �' / = ;\'5, CITY OF ATLANTIC BEACH
„ , j 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-3692
Job Type: PLUMBING ONLY
Description: water treating system
Estimated Value: $66.00
Issue Date: 4/6/2017
Expiration Date: 10/3/2017
PROPERTY ADDRESS:
Address: 1476 LAUREL WAY
RE Number: 170704-0060
PROPERTY OWNER:
Name: Graham, Cathy
Address:
GENERAL CONTRACTOR INFORMATION:
Name: AFFORDABLE WATER/KINDER INC
,JAX SPEC W-32
Address: 3760 KORI RD SPECIALTY WATER (CONS TDS QB)
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
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORID:k
BUILDING CODES.
PLUMBING PERMIT APPLICATION
• CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845 il-P(,13C'? -30q a
JOB ADDRESS: Ll i Is Lau r e I LAJAy At Lcu-11-c, 13eac.h PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value $ talo • °d
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 l
RE-PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub - Septic Tank & Pit
'_ r Shower
Clothes Washer 1 l
Dishwasher I Shower Pan
Drinking Fountain J �` Slop Sink
Dr g .c1
Floor Drain I Three Compartment Sink
Floor Sink APR - 5 2017 11 Toilet
Hose Bibs L Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray 1 Water Connected Appliances
Lavatory —� Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
El Sewer Replacement D Back Flow Preventer n 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
i
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
his 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
nor not. The permit does not give authority to violate the provisions of any other state or local law regulation construction or the erfofmance of construction.
141 -
Property Owners Name CIA TN V G KA i-I A M Phone Number 73 0-f
Plumbing Company 809 LI
Com an / FFo2DABLE 1�1IA tcR Office Phone°Zlo2-c/97 Faxg0260-6,29V-
Co. Address: 3'7( O K0 izi R CJ City j ck5oni,1 le State FL- Zip 022-5r.
License Holder(Print): m A K I A . I<i iti 0 c State Ce ification/Registration # 000 81810
Notarized Signature of License Holder
Sworn and subscribed be me this 3 day of n p P.t!_. 20 17
li.►M NOW/Public State of Florida
�.. DoMy CommissionrM.
evG081383 Signature of Notary P tic 1 1
a Or Expires 02/09/2021 I