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