1644 PARK TER W - PLUMBING SS1
CITY OF ATLANTIC
_ 800 SEMINOLEBEACHD ROA
;r ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 17-PLBG-3769
Job Type: PLUMBING ONLY
Description: PLUMBING - 11 FIXTURES
Estimated Value:
Issue Date: 4/14/2017
Expiration Date: 10/11/2017
PROPERTY ADDRESS:
Address: 1644 W PARK TER
RE Number: 172020-0164
PROPERTY OWNER:
Name: Gramling, Scott And KELLY
Address: 1644 Park TER
GENERAL CONTRACTOR INFORMATION:
Name: WAYNE CONN PLUMBING INC.
Vernon J. Sparks, CFC1428564
Address: 6915 W BEAVER ST
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $77.00
Trade Permit Base Fee $55.00
Total Payments: $136.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
&ig/4/6(//41 800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845 ( 7_P LB -3 7( /
JOB ADDRESS: / /, /39X eAA4 PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
BathtubSeptic 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:
o Sewer Replacement ❑ Back Flow Preventer ❑ 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.
❑ 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 G /y//i f Phone Number
Plumbing Company El/iv/tie 4a/04i/41,6/%7i Office Phonc 3/dot Fax��
Co. Address: ?O.- 41 S'_.../YY City'-4 State % Zir 9 fV
License Holder(Print): Git) 14-'4- . . State Certification/Re•istration#4Fc 757.62-Z 5'
Notarized Signature of License Holder PAI(IP....
u --��,�--'.,.'..r.a-•- • Before me this I da In(s) ►Al A 1 20
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. •'•�'r':-- --'--2----'
TONI GINDLESPERGER
`'= MY COMMISSION#FF 92=951 1
EXPIRES.October 6,2016 Signature of Notary Publics
1f,; �S°� Becd i hr�Notary Publr Unde wrlers