195 SEMINOLE RD - PLUMBING . iii .f CITY OF ATLANTIC BEACH
,a" 0 800 SEMINOLE ROAD
`514° x ATLANTIC BEACH, FL 32233
''.2-011 >%' INSPECTION PHONE LINE 247-5814
PLUMBING RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: PLRS17-0120
Description: install 18 fixtures
Estimated Value: 0
Issue Date: 10/17/2017
Expiration Date: 4/15/2018
PROPERTY ADDRESS:
Address: 195 SEMINOLE RD
RE Number: 170604 0000
PROPERTY OWNER:
Name: MICROBIAL NATURAL PRODUCTS INC
Address: 1207 SEMINOLE RD
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: BROADWELL BUILDERS
Address: 335 COUNTRY CLUB LN JOHN PATRICK BROADWELL
ATLANTIC BEACH, FL 32233
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$7,500.
PLUMBING PERMIT APPLICATION (§
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845 PL R.5 I-' Q 0,-D
JOB ADDRESS: I q 5 1 IV&OI PERMIT# 9ES 11-007
NEW OR REPLACEMENT INSTALLATION: Project Value$
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 1
Hose Bibs .Z Urinal
Kitchen Sink / Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 5 Water Heater /
Other Fixtures 2- 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 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 H Back Flow Preventer ❑ Grease Interceptor (Trap) gallons(Requires 3 sets of plans)
H Lawn Sprinkler System-Number of Heads ❑ 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 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 X74 /31,4/ /� ,iZ ,i/ `n>•24
/CD/31,47 Phone Number 90 ‘ 1.//''4/24/9
Plumbing Company AMCI IA..-Pi 1.0-4161 -410.... Offic Phone a`te-.150 Fax d d,:)'5345--
Co. Address: calor] t&Ek_r----4- City 16-- State 51 Zip J)-.).4)(0e
License Holder (Print): 0 4 \\ State .e • . ation/Registration# QfQ65lW 4 I
Notarized Signature of License Holderi . 2,/
--;0: . '4, JENNIFER JOHNSTON Sworn and subscribed before me this \I- day of 0 C'�Q�r 20
•' MY COMMISSION#GG 042984
"' �"4' •vi EXPIRES:October 27,2020 i
o Bonded Thru Notary Public Underwriters Signature of Notary Public \ / A
1