1872 HICKORY LN - PLUMBING (2) �3 • el
'1' CITY OF ATLANTIC BEACH
s� 800 SEMINOLE ROAD
7.511
ATLANTIC BEACH, FL 32233
P-tost INSPECTION PHONE LINE 247-5814
PLUMBING RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: PLRS17-0106
Description: RE PIPE- 15 FIXTURES
Estimated Value: 0
Issue Date: 9/28/2017
Expiration Date: 3/27/2018
PROPERTY ADDRESS:
Address: 1872 HICKORY LN
RE Number: 172020 1458
PROPERTY OWNER:
Name: **CONFIDENTIAL **
Address: **CONFIDENTIAL ****CONFIDENTIAL **
**CONF **, XX#####
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: B & G PLUMBING CO., INC.
Address: 2232 CORPORATE SQUARE BLVD 2232 CORPORATE
SQUARE BLVD
JACKSONVILLE, FL 32216
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.
Cash Register Receipt Receipt Number
)r City of Atlantic Beach R2940
DESCRIPTION I ACCOUNT QTY PAID
PermitTRAK $164.40
PLRS17-0106 Address: 1872 HICKORY LN APN: 172020 1458 $164.40
PLUMBING $160.00
PLUMBING BASE FEE 455-0000-322-1000 0 $55.00
PLUMBING FIXTURES 455-0000-322-1000 15 $105.00
STATE SURCHARGES $4.40
STATE DBPR SURCHARGE 455-0000-208-0600 0 $2.40
STATE DCA SURCHARGE 45500002080700 0 $2.00
TOTAL FEES PAID BY RECEIPT: R2940 $164.40
CITY OF ATLANTIC BEACH
800 SEMINOLE RD
ATLANTIC BEAC,FL 32233
0928.2017 14:25:54
CREDIT CARD
VISA SALE
Card a XXXXXXXXXI(XX8414
SEQ;: 8
Batch;?: 451
INVOICE 8
Approval Code: 021576
Entry Method: Manual
Mode: Onlive
Tax Amount: $0.00
Card Code: M
SALE AMOUNT $164,40
CUSTOMER COPY
Date Paid:Thursday, September 28, 2017
Paid By: ** CONFIDENTIAL **
Cashier: BA
Pay Method: CREDIT CARD 8
/pi
Printed:Thursday,September 28,2017 2:26 PM 1 of 1
TRNUT
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904) 247-5845 PL I. ( 7_O( o ,
1013 ADDRESS: 18-t2 fh C IDI,y L Cl PERMIT#
i.EW OR REPLACEMENT INSTALLATION: Project Value$ -
TYPE OF FIXTURE OTY TYPE OF FIXTURE OTY
Bathtub Septic:Tank&Pit
Clothes Washer Shower _
Dishwasher - Show.r 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
RE-PIPE: 7
TYPE OF FIXTURE OTY 1,D TYPE OF FIXTURE QTY
Bathtub -2- Septio Tank&Pit _ —
Clothes Washer I Shower
Dishwasher 4 Shower Pan - —
Drinking Fountain — Slop sink —
Floor Drain — Three Compartment Sink —
Floor Sink — Toilet __?__—
Hose Bibs 3 Urinzl —
Kitchen Sink I Vacuum Breakers —
Laundry Tray - Water Connected Appliances I
Lavatory - Z Water Heater - t
Other Fixtures — Water Treating System
MISCELLANEOUS:
o Sewer Replacement 0 Back Flow Preventer 0 Grease Interceptor(Trap) gallons(Requires 3 sets of plans'
o Lawn Sprinkler System-Number of Heads 0 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 suspentled or abandoned for six months.I hereby certify that I have rea
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 b a n e p I eY s o h Phone Number q 04— 811 — 2(c 18
Plumbing Company $& 61 F1 U I I ,I h 9 , (0. _Office Phone 90 4-223 -3585 Fax go 4-22.3-3IBC
Co. Address: 1232 Covpovate Si,uave 13Ivci City Tcc.-csonville State FL Zip 32-_1(0
LicenseHolder (Print): (len e G• lis O V e 14 / ate Certification/Registration# C FG 0 22 5-(13
NotarizedNotarizedSignatureafure of License HolderHolderu-L" ,,/
worn and subscribed before n •tis - dayof 2O/ r
o� ri LORI S.NOROGREN P -. .--
40 —
Notary Public-Stab of Florida
0 •f Commbsion 0 FF 147330 ?ignature of Notary Public gib' . s 1 . ..�e.4A.� --- _--
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