1675 BEACH DR - PERMIT IRR18-0030 PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904)247-5845 IL V- 1 _ 00 3
JOB ADDRESS: /6 75 Ber4Ck Qve_ 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 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 'Back Flow Preventer 0 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 tittal 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 regguul ti�cu A cti6n or the performance of construction.
Property Owners Name Anne erlexe t e. ,,row i s)-J Phone Number((q)rya?-o396
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Plumbing Company /.a&/'1 Trif o 41" -W-vbexs Ltd- Office Phone op1{1 Y - " Fax
Co. Address: c16°41 ‘ • h j' ,4c e- (-'J' City "l , l'' State d Zip 3a.-7J3
License Holder(Print): A i a't a t I kO-71- State Certification/Registration# . 90-9
Notarized Signature of License Holder 7L--- ,,.... =221'=
t ,s.: : ;. JENNIFER JOHNSTON Sworn and subscribed before me t is day of Ray 20 1 S
a= •• I.\ •• . MY COMMISSION#GG 042984
=�: °" EXPIRES:October 27,2020
.„p yqP'' Bonded Thru Notary Public Underwriters
Signature of Notary Public
_i tai ♦ e.