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1146 Beach AVe PLRS18-0183pt �Lrri., CITY OF ATLANTIC BEACH f, 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: PLRS18-0183 Description: Repipe Estimated Value: 7000 Issue Date: 8/8/2018 Expiration Date: 2/4/2019 PROPERTY ADDRESS: Address: RE Number: 1146 BEACH AVE 170280 0000 PROPERTY OVINER: Name: NORDAN KERRY GENE Address: 1146 BEACH AVE ATLANTIC BEACH, FL 322335728 GENERAL CONTRACTOR INFORMATION: Name: Address: Phone: Name: EMERGENCY REPAIR PLUMBING INC Address: 1195 WHISPERING PINES RD CIA EDSEL FORD GOFF, JR JACKSONVILLE, FL 32259 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. NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that may be found in the public records of this county, and there may be additional permits required from other governmental entities such as water management districts state agencies or federal agencies. • 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 0Fax(904)247-5845 1 JOB ADDRESS: LAta &onch Aue PERmrrV -0l NEW OR REPLACEMENT INSTALLATION: RE -PIPE: TYPE of,FixTURE Bathtub Clothes Washer Dishwasher Drinking Fountain Floor Drain Floor Sink Hose Bibs Kitchen Sink Laundry Tray Lavatory Other Fixtures TYPE OFF/XTURE Bathtub Clothes Washer Dishwasher Drinking Fountain Floor Drain Floor Sink Hose Bibs Kitchen Sink Laundry Tray Lavatory Other Fixtures QTY Project Value S "A TYPE oFFixTURE QTY t QTY MISCELLANEOUS: ❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans) ❑ Lawn Sprinkler System -Number of Heads ❑ Well •` ** S/RWD 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. l 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 stale or local law regulation construction or the performance of construction. Property Owners Name _\ e Qv\ Mo C Q Phone Number Plumbing Company r[z InC 9%pQlir P�!tM10\knroffice Phone Fax Co. Address: %\q!S City State _ Zip License Holder (Print): Notarized Signature of License Holder 'Zr=& u eX J`I R=Sworn and subscribed before IE4Tanazase Signature of Notary Publicl.mmundemrs rIM Septic Tank & Pit Shower Shower Pan Slop Sink Three Compartment Sink Toilet Urinal Vacuum Breakers Water Connected Appliances Water Heater Water Treating System QTY TYPEoFFIXTURE Septic Tank & Pit Shower Shower Pan Slop Sink Three Compartment Sink Toilet Urinal Vacuum Breakers Water Connected Appliances Water Heater Water Treating System t QTY MISCELLANEOUS: ❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans) ❑ Lawn Sprinkler System -Number of Heads ❑ Well •` ** S/RWD 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. l 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 stale or local law regulation construction or the performance of construction. Property Owners Name _\ e Qv\ Mo C Q Phone Number Plumbing Company r[z InC 9%pQlir P�!tM10\knroffice Phone Fax Co. Address: %\q!S City State _ Zip License Holder (Print): Notarized Signature of License Holder 'Zr=& u eX J`I R=Sworn and subscribed before IE4Tanazase Signature of Notary Publicl.mmundemrs rIM