1957 SEMINOLE RD WATER HEATER .� � ` � CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
"--013 S)% INSPECTION PHONE LINE 247-5814
PLUMBING RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: PLRS17-0075
Description: WATER HEATER
Estimated Value: 0
Issue Date:
Expiration Date:
PROPERTY ADDRESS:
Address: 1957 SEMINOLE RD
RE Number: 169542 0512
PROPERTY OWNER:
Name: MAYEDO CAROLE ANN
Address: 1957 SEMINOLE RD
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: COGBURN AND WAKEFIELD PLBG
Address: 5900 TOWNSEND BLVD APT 522 QA JOHN COGBURN
JACKSONVILLE, FL 32211
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$7,500.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax (904) 247-5845 P L RS i 7-0075
JOB ADDRESS: 1 I s----7 . ,moo c •. PERMIT#
•
NEW OR REPLACEMENT INSTALLATION: Project Value$
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 Compal tuient Sink '
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater f
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 SlopSink
Floor Drain Thre 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 0 Back Flow Preventer 0 Grease Interceptor (Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads o Well ** . •
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
o 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.
1 u
Property Owners Name kQ 1.e Phone Number
Plumbing Company Co 1:),J13,--) 4--(,-)t� c_e..(c)( >�kvM b 1 is--?i,Office Phone 3 3 `l-3�S 3 Fax
Co. Address: (9 SO 1 J I Al , � S. City'1" -1-4"( State CA- Zip 3 ZZ 1 o
License Holder(Print): Statertification/Re istration# CFC ►`(2.F1 Yd
•
jar / g
Notarized Signature of License Holder _
.4F:y••. Tom GINDLESPERGE„ Before me t 1 S day O fit (1A 20 C-7*•.c�� 2 MY COMMISSION#rr"924951 0
,eEXPIRES.October 6,2019 �. trill /
t:97,°:' Bonded Thru Notary Public Underw,lers oignature of Notary Public - �../