2133 SEMINOLE RD - PLUMBING „ ,,,..„
.�� ,, CITY OF ATLANTIC BEACH
�' ” s 800 SEMINOLE ROAD
\,,,,,.._� vATLANTIC BEACH, FL 32233
r stiO' INSPECTION PHONE LINE 247-5814
PLUMBING RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: PLRS17-0079
Description: 3 FIXTURES
Estimated Value: 0
Issue Date: 8/16/2017
Expiration Date: 2/12/2018
PROPERTY ADDRESS:
Address: 2133 SEMINOLE RD 1
RE Number: 169515 0430
PROPERTY OWNER:
Name: COOPER DIANNE
Address: 2133-1 SEMINOLE RD
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name:
Address:
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$7,500.
0
I
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845 P U25(7—00 79
JOB ADDRESS: ))33 c‘,/)n/)'t. (zit °/ PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
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 2- _ Water Heater
Other Fixtures Water Treating System
RE-PIPE: 16
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 _.;,.i
MISCELLANEOUS:
o 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.**
❑ Other
Permit becomes void if work does not commence within a six month 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 A/AA e &rt., Phone Number #7A:5141
flS5 4 ] r •
70.1/.11 Fax
Plumbing Company y,L Office Phone
Co. Address:
/0 A 5r City R7 JM Stated Zip.: 33
License Holder(Print): -7/71/1 /k.,
State Certification/Registration 10,6037114
Notarized Signature_of License Holder I r) '`, , `�
_____________
1 ,'S ' TONI GINDLESPERGEn' // day2 1 /
• . Before a this
,. '= MY COMMISSION#FF 524951 I /
'�.. :a EXPIRES:October 6, eOr Signature of Notary Public _ 0 c
"0.:�' Bonded Thru Notary Pubiic Under+r,ters