825 SHERRY DR - PLUMBING CITY OF ATLANTIC BEACH
rsVi` '' S 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: PLRS17-0036
Description: 20 FIXTURES
Estimated Value: 0
Issue Date:
Expiration Date:
PROPERTY ADDRESS:
Address: 825 SHERRY DR
RE Number: 169983 0000
PROPERTY OWNER:
Name: ADAM GRAY
Address: 826 9TH AVE N
JACKSONVILLE BEACH, FL 32250
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: QUALITY PLUMBING OF GAINESVILLE INC
Address: 6318 NW 18TH DRIVE
GAINESVILLE, FL 32653
Phone:
PERMIT INFORMATION:
Please see attached conditions of approval.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMENT MAY RESULT IN YOU PAYING TWICE FOR
IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF
COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB
SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN
FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
* A notice of Commencement is only required for work exceeding an estimated value of
$2,500. For HVAC work, a Notice of Commencement is only required when HVAC work
exceeds and estimated value of$7,500.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904)247-5845 ID L ��S i 7 - 0,03k ,
JOB ADDRESS: �� S 1.e..-(rL-/ Dii v 1 p-ii,„t; iI,•-G i-, PERMIT# 12.& S I7- coil
NEW OR REPLACEMENT INSTALLATION: Project Value S 'E, vvC
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer I Shower
Dishwasher I Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs a. Urinal
Kitchen Sink ___L.._ Vacuum Breakers
Laundry Tray _ 1 Water Connected Appliances
Lavatory _ S Water Heater
Other Fixtures 7 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:
El Sewer Replacement C Back Flow Preventer D Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
D Lawn Sprinkler System-Number of Heads ❑ Well **
**SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
D 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 ,,4�-- Ur'--� ' Phone Number
Plumbing Company ( /( ki T k-' t%/ v 6.--u+^v-rir 1 It-Office Phone 'S:a-077-1w9 Fax
Co. Address: -751` M-) 1 e- f v'-- City %•�-r,�r-sem;I1c State rc- Zip 13# '5 3
License Holder(Print): 7Y/'h't Iix04fl late Certification/Registration# e-F-C°4 34173
. . s lder- -
,.*.."(4,i,„- WILLIAM FRANKLIN ANDREWS,JR. Sworn and subscribed before me this Z d'y of 3�h r- 20 I.
.... IL0.°E Notary Public•State of Florida (�
ail .. My Comm.Expires Dec 16.2018 ` 19
.--
---;:"'e-w-4-4. Signature of Notary Public \ : _46_ _
, ,,,. Commission FF 152352
Cash Register Receipt Receipt Number
City of Atlantic Beach R1848
DESCRIPTION I ACCOUNT I QTY I PAID
PermitTRAK $200.86
PLRS17-0036 Address: 825 SHERRY DR APN: 169983 0000 $200.86
PLUMBING $195.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 20 $140.00
STATE SURCHARGES $5.86
STATE DBPR SURCHARGE 455-0000-208-0600 0 $2.93
STATE DCA SURCHARGE 455-0000-208-0700 0 $2.93
TOTAL FEES PAID BY RECEIPT: R1848 $200.86
Date Paid: Monday, June 26, 2017
Paid By: QUALITY PLUMBING OF GAINESVILL
Cashier: CT
Pay Method: CREDIT CARD 516255
S
Printed: Monday,June 26, 2017 4:56 PM 1 of 1
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