510 SELVA LAKES CIR - PLUMBING -j1,J-A1/\
�S CITY OF ATLANTIC BEACH
"�• y f 800 SEMINOLE ROAD
`� ''� 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-3809
Job Type: PLUMBING ONLY
Description: re-pipe 15 fixtures
Estimated Value:
Issue Date: 4/24/2017
Expiration Date: 10/21/2017 _
PROPERTY ADDRESS:
Address: 510 SELVA LAKES CIR
RE Number: 172027-5604
PROPERTY OWNER:
Name: COOPER, THERESA M
Address: 1172 SMITHVILLE RD
GENERAL CONTRACTOR INFORMATION:
Name: ADVANTAGE PLUMBING
Gregory K. Gause, CFC1425959
Address: 880 MAYPORT RD QA GREG GAUSE
Phone: - -
FEES:
Plumbing Fixtures $105.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Trade Permit Base Fee $55.00
Total Payments: $164.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
Bill DING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax (904) 247-5845 1 1—1A-13C-1—3$O
JOB ADDRESS: 2() _5?/U, 4,4,5 [ //Q 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 I Shower 2
Dishwasher i Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs 2 Urinal
Kitchen Sink / Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 3 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 0 Well **
**SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
0 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 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 / _e (°5.1 r /P Phone Number
Plumbing Company p y - 0 V//,`.1/4/747 10)0"3/A7(7 Office Phone o2Y7- g6VC Fax„2y7- Q69/
Co. Address: g6 O 11/)19-y nc, ( --.3 City ?L, i?, 4 --, State fi Zip 3.2c233
License Holder(Print): 4R�- C-7,105 / tate Certification/Registration# (WV f 9,PS-K9
Notarized Signature __ •• . -older --& C
\.• Yi JENNIFER JOHNSTON
• ��'"'• gg My COMMISSION N GG 042984 Before me thi . ay of 4 ( 20
ti .t3 EXPIRES:October 27,2020
,• r'e &mowThruNotaryPublzUnderwribrs Signature o otary Public u