1871 SELVA MARINA DR - PLUMBING Sty CITY OF ATLANTIC BEACH
IC. • 800 SEMINOLE ROAD
J �r 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-3849
Job Type: PLUMBING ONLY
Description: PLUMBING - 21 FIXTURES
Estimated Value: $1,800.00
Issue Date: 4/27/2017
Expiration Date: 10/24/2017
PROPERTY ADDRESS:
Address: 1871 SELVA MARINA DR
RE Number: 172020-0846
PROPERTY OWNER:
Name: POWELL, GREGORY M
Address: 1871 SELVA MARINA DR
GENERAL CONTRACTOR INFORMATION:
Name: ROTO ROOTER SERVICES
, CFC 057629
Address: 2028 W 21ST ST
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $147.00
Trade Permit Base Fee $55.00
Total Payments: $206.00
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
800 Seminole Rd Atlantic Beach, FL 32233 2
Ph (904) 247-5826 Fax (904)247-5845 � _/ - Pc-6 e -3849
JOB ADDRESS: /2')1/ LS -k,+ /1"14,e_/<_i A '2-I1/4,E PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Values 4 PW
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
LavatoryWater Heater
Other Fixtures \ Water Treating System
RE-PIPE: //I%
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub ,3 Septic Tank& Pit
Clothes Washer _L___ 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 A Water Treating System
MISCELLANEOUS:
ri Sewer Replacement 0 Back Flow Preventer ,_-_l Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
0 Lawn Sprinkler System-Number of Heads Well **
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
O Other
Permit becomes void if work docs 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 au ority to violatg the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name /1-R-01-- PO to C /-',- Phone Number 40V- 9?3. OP 7P
Plumbing Company Ko-ro leOOTE' Office Phonego'/'3S`/"73-2/ Fax 9ov 3,5&CI
Co. Address: ' 62aP POE-- .51-- a/6T L -E-6-7- City 6Dv/-4- State FA- Zip k3-7.z09
License Holder(Print): ib ,C . (�Q�(3c ).Ga a_ State Certification/Registration #er-60,5'7/0-29
Notarized Signature of License Holder �\ Jit-tk-"----------'1
worn and subscribed before me t is ''° day of 4,m /(--- 20 /g
.x%4.1 CommiKARENssion
S.Jn#FF 1 AUS
929 �� 2
'� .� '�= Commission�FF 179297 ignature of Notary Public K.X�
41.1 Expires November 25,2018
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ATLANTIC BEACH
PERMIT RECEIPT
April 27, 2017
PERMIT DESCRIPTION: PLUMBING - 21 FIXTURES
PERMIT NUMBER: 17-PLBG-3849
ADDRESS: 1871 SELVA MARINA DR CITY OF ATLANTIC BEACH
800 SEMINOLE RD
OWNER: ATLANTIC RAC,FL 32233
04,272017 10:07:01
State PLMG DBPR Surcharge $2.00 CREDIT CARD
MC SALE
State PLMG DCA Surcharge $2.00 CARD XXXXXXXXXXXX802B
INVOICE 0001
SEQ 4: 0001
Plumbing Fixtures $147.00 Batch;: 000549
Approval Code: 061263
Entry Method:
Manual
Trade Permit Base Fee $55.00 Mode: Online
Tax Amount: $0.00
Cust Code:
Card Code:
Totals:
$206.00 SALE AMOUNT $106,00
CUSTOMER COPY
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