845 PLAZA - PLUMBING , `', CITY OF ATLANTIC BEACH
501 v :--*2:,7.;:- 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
'401119:>" INSPECTION PHONE1INE 247-5814
PLUMBING RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: PLRS17-0162
Description: 4 FIXTURES
Estimated Value: 0
Issue Date: 12/11/2017
Expiration Date: 6/9/2018
PROPERTY ADDRESS:
Address: 845 PLAZA
RE Number: 171111 0000
PROPERTY OWNER:
Name: BOURGEOIS MICHAEL R LIFE ESTATE
Address: CIO ALFRED L BOURGEOIS16117 SHELLCRACKER RD
JACKSONVILLE, FL 32226
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
,
Phone:
Name: TDG PLUMBING
Address: 4426 LOYS DR QA TRAVIS DALE GAINEY
JACKSONVILLE, FL 32246
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$7,500.
PLUMBING PEIIIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233 �� ��_�
Ph(904) 247-5826 Fax (904) 247-5845 Pi�
( Co Z-
JOB ADDRESS: 53 LIS eLAZv) PERMIT# 1'1 Ook(A
NEW OR REPLACEMENT INSTALLATION: Project Value$
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 t
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatoiy 71-- Water Heater
Other Fixtures Water Treating System
GkRE-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:
D Sewer Replacement o Back Flow Preventer 0 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
O Lawn Sprinkler System-Number of Heads 0 Well **
x 8..JRWD 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.l 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 slate or local law regulation construction or the performance of construction.
Property Owners Name 6 A4\1,611.n {if4T t t"<€.4 i n W.R J►i1 J Phone Number
Plumbing Company 13 (. \ v.:jo'N i Office Phone Fax S1,4 t*Sa
Co. Address: 4 ( 'Lc CL State f L Zip V22L S'
License Holder(Prin7)77a. 1 Co - N' State Certification/Registration#
Notarized Signature of License Holder
W = ==='= Before me this l day o ret. �' '0 7
�r v TONT GINDLESPERGER �
41P t, PAY COMMISSION tt FF 924951
Il EXPIRES:October 6,2019 Signature of Notary Public • a
tti° Bonded Thru Notary Public Undervinters ,