364 4th Street A - WATER SERVICE ,:,,,„,`I rJv,
`��iiiit � CITY OF ATLANTIC BEACH
r' > 800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
'"!J;3 v INSPECTION PHONE LINE 247-5814
PLUMBING RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: PLRS18-0018
Description: Replace Water Service
Estimated Value: 0
Issue Date: 1/18/2018
Expiration Date: 7/17/2018
PROPERTY ADDRESS:
Address: 364 4TH ST A
RE Number: 169824 0002
PROPERTY OWNER:
Name: FOX LAURA A ET AL
Address: 352 7TH ST
ATLANTIC BEACH, FL 32233-5434
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: F.W. FAIR PLUMBING CO.
Address: P 0 DRAWER 51558 P.O. DRAWER 51558
JACKSONVILLE BEACH, FL 32250
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$7,500.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax(904)247-5845ajz_ I�vel
JOB ADDRESS: PERMIT # ;G._- ---------
NEW OR REPLACEMENT INSTALLATION: Project Value$
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 Water Heater
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 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:
o Sewer Replacement 0 Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads 0 Well **
**SJRWDDWell Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ Other 'ctpv..- cv,S-rte J J1 as
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
1(3
-' P.one N as ber l
Plumbing Company f P/ (id P / Office Phon- �1 ( 7"?Fax
Co. Address: ,d.0_ g 0>( s--/ -0,) Ci Stahl' Zip 37,1/Y
License Holder (Print): ,(i-9 ' State Certification/Registration d P Ob 3 7,(1) 3
Notarized Signature of License Holder `�
` of"`•!:e. PAMVIN VERNON DUPREE Sworn and subscribed before me 's /87�i,day of J`1 11111 20 1 g
* i_� Ir COMMISSION#FF 147645
nn EXPIRES:Augusto,2018 Signature of Notary Public 0044t. v / zxx--
�19TFOF F,*o! Bonded Thru Budget Notary Sm ices