543 PELICAN KEY - PLUMBING e , CITY OF ATLANTIC BEACH
> ll 800 SEMINOLE ROAD
Kliy, .._I� ' �� . ATLANTIC BEACH, FL 32233
j7 INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-PLBG-3721
Job Type: PLUMBING ONLY
Description: install kitchen sink & icemaker
Estimated Value: $700.00
Issue Date: 4/10/2017
Expiration Date: 10/7/2017
PROPERTY ADDRESS:
Address: 543 PELICAN KEY
RE Number: 172027-5582
PROPERTY OWNER:
Name: URBAN, STEPHEN
Address: 543 PELICAN KEY
GENERAL CONTRACTOR INFORMATION:
Name: EARY PLUMBING
Benjamin Paul Eary, CFC 1428812
Address: 1870 Swiss Oaks St ST
Phone: 904-460-3438
FEES:
Plumbing Fixtures $14.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $73.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT
APPLICATION 0
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904) 247-5845 1 1 - pc 6ci— 'n6(
JOB ADDRESS: fyjpe 1 `CUh / '' PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$ 700
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 ___L__ Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures •�Ewu. r 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 , f°f
MISCELLANEOUS:
o Sewer Replacement ❑ Back Flow Preventer 0 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads
0 Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
O Other
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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 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 f 4c I Or ,-► Phone Number
Plumbing Company fO Phu*lib,i , Office Phone /p0 06 OJ/ p Fax
Co. Address: /8'2D ic..../ 5
C4.5- (5-•1-_ City. Si" Toil w S Statefi Zip ?22,57
License Holder(Print): )5o-wt;ri F State Certification/Registration# C FC W? 81/2
.c-
Notarized
Notarized Signature of License Holder
'?q;a %yJENNIFER JOHNSTON Before me this 10-\- - day of Apc`\ 20
• •• ,a, :M: MY COMMISSION#GG 042984 i b
-�:o EXPIRES:October 27.2020 Signature of Notary Public �tvt
'-t„07;;.?!;.:
Bonded Thru Notary Public Undenxiters