522 PLAZA PLBG 8 FIX 2017 ?5�1�
CITY OF ATLANTIC BEACH
"' - 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
� ,3 0• V INSPECTION PHONE LINE 247-5814
PLUMBING RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: PLRS17-0022
Description: 8 FIXTURES
Estimated Value: 0
Issue Date: 6/6/2017
Expiration Date: 12/3/2017
PROPERTY ADDRESS:
Address: 522 PLAZA
RE Number: 170703 0204
PROPERTY OWNER:
Name: KUDER DANIELT
Address: 522 PLAZA
ATLANTIC BEACH, FL 32233-4123
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: DALE'S PLUMBING COMPANY
Address: 688-C Kingsley Ave Orange PARK
ORANGE PARK, FL 32073
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$7,500.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
�^ Ph(904)247-5826 Fax(904) 247-5845 P LRS 1 7—00 Z Z
JOB ADDRESS: J �4 PERMIT#
i7 -9100 -J77Y- a/
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPEOFF=RE QTY TYPEOFFMWRE QTY
Bathtub Septic Tank&Pit
Clothes Washer _� Shower
Dishwasher �_ Shower Pan
Drinking FountainSlap Sink
Floor Drain Twee Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink _L Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures _� Water Treating System
RE-PIPE:
TYPEOFFEvYuRE QTY TYPE OFFMTORE 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:
❑ Sewer Replacement Cl Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads 17 Well **
**SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ 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 end ordinances governing this work will be complied with whether specified i
or not the permit does not give at ority to violate the provi 'ons of any other some or local law regulmion construction orthe performance of construction.
Property Owners Name Q O.IS U Phone Number
.72
Plumbing Company 4 let✓ 7 U A7' 1112, Office Phone /, , - IV Fax 0 F2_Y
Co.Address: D�- v City"` k State FI—Zip J-�O 7,7
License Holder(Print): Jos. State Cern catiion/Registration# CF<70 AUd$
Notarized Signature oJLicense older
Ewlif
1011 GINOIESPniGm efore m ayofMY COMMISSICM i FF 924951
EXPIRES:0clax6,2019
ignature of Notary Public