337 7th St PLRS20-0092 plbg permitr[
-- s, Plumbing Permit Application
City of Atlantic Beach Building Department
800 Seminole Rd, Atlantic Beach, FL 32233
=f Phone: (904) 247-5826 Email: Building-Dept@coab.us
**ALL INFORMATION
HIGHLIGHTED IN
GRAY IS REQUIRED.
PERMIT #:
JOB ADDRESS: ?i3 -7 ? :5"YR1�ifi' PROJECT VALUE $
✓❑11EW R REPLACEMEN NSTALLATION and/or [IRE -PIPE
TYPE OF FIXTURE QTY
TYPE OF FIXTURE
QTY
Bathtub
Septic Tank & Pit
AA5_f�1U*?tti9Phone:
Clothes Washer
Shower
Dishwasher
Shower Pan
Drinking Fountain
Slop Sink
Floor Drain
Three Compartment Sink
Floor Sink
Toilipt
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
❑ Lawn Sprinkler System (number of sprinkler heads)
05rease Interceptor (Trap) gallons (Requires 3 sets of plans)
❑ Well ** SJRWD 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.
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.
Owner Name: 011 MA01,�i
lJ�
Phone Number:
Plumbing Company: ��l
AA5_f�1U*?tti9Phone:
Fax tQeg6 %31":5
Co. Address: 365.3���u�-.�o�
License Holder: I04YOMS PA -9915W _L_
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this
County of :DUVAL.
City: State: Pt -zip: u -'Z
gistration # L"t' e O✓"a.:04"?
Z` day ofg KLt 6 , 20 Z:Q in the State of Florida,
s"` P•?i % ° �—�
Public Signature of Notary
o:
CHE
MY COMMISSION # GG 117147
;r '' EXPIRES:June 21,2021 [personally Known OR [
• Bonded Thru Notary Public Underwriters
Type of Identification: _
] Produced Identification
Updated 10/17/18