1600 Atlantic Beach Dr plbg permit s"Lyi'Iv
1 % CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING RESIDENTIAL -
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
PERMIT INFORMATION:
PERMIT NO: PLRS17-0123
Description: 18 fixtures
Estimated Value: 0
Issue Date: 10/23/2017
Expiration Date: 4/21/2018
PROPERTY ADDRESS:
Address: 550 ATLANTIC BEACH DR
RE Number: 169505 1140
PROPERTY OWNER:
Name: TOUSEY CLAY B
Address: 2225 ALICIA LN
ATLANTIC BEACH, FL 32233
GENERAL CONTRACTOR INFORMATION:
Name:
Address:
Phone:
Name: CUSTOM PLUMBING AND TILE
Address: 2742 SETTLEMENT DR QA THOMAS MICHAEL BLACKBURN
JACKSONVILLE, FL 32226
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 � ��-a -3
.TOB ADDRESS: SSD A71-w%k- 4?eae/ A/C PERMIT# /RCT77---(�;75Y
NEW OR REPLACEMENT INSTALLATION: Project Values
TYPE OF FIXTURE QTY TYPE OF FIXTURE
Bathtub Septic Tank&Pit
Clothes Washer 1 Shower
Dishwasher _� Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs 2. Urinal
Kitchen Sink I 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
I Hose Bibs Urinal
' Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads t.i Well **
**SIRWD 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 wort:is suspended or abandoned for six month..I hereby certify that 1 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
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Phone Number
Plumbing Company 1.US�o nit f JuNt.b im + 4,-a w- Office Phone fbo-J`l57 Fax
Co. Address: X Y2- City X State r1 Zip 3 Z L 7-
License
License Holder(Print):- State Certification/Registration# CFC JAZZ 3�f°/
Notarized Signature of License Holder 6A_�7
More nee I�u��G.r� day of C 20�_ �� 7h
r •�'�►"••. GRACE MACKEY C f p
Signature of Notary Public
MY COMMISSION#GG 042989 r _
i EXPIRES:October 27,2020
Bonded ThruNotary Public Undernriters
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