359 SHERRY DR - PLRS20-0143 Plumbing Permit Application **ALLINFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233 -t43
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: LRS
JOB ADDRESS: 35/ She-rry pri ii. 11M Lf'c-I _ 37233 PROJECT VALUE $ f Pin •C
dVEW OR REPLACEMENT INSTALLATION and/or ORE-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 I Water Heater
Other Fixtures Water Treating System
❑VIISCELLANEOUS
CISewer Replacement
DBack Flow Preventer
Cl Lawn Sprinkler System (number of sprinkler heads)
Erease 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. **
DOther Reloca4e Tce A&akt , Movc-pipes,' s-Fo►-Q( of vt 1 r - •
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: Joign lR. TV Con, Jr. Phone Number: q01-Zifq-2758
Plumbing Company: J oL'w 12. MDovl 1)(1)A4131 Office Phone: golf-zip-2758 Fax
Co. Address: 1602 W eS1 v4 Sf City: A4-64.41t. t3d State: FL-Zip: • 2.2_33
License Holder: JO , ' • i'V100N ..• . State Certifi tion/Registration # 'FGO f 9 ZO O
Notarized Signature of License Holder 1�
The foreg strument as acknowledges/efore me thisV �day of , 20 the State of Florida,
County of� rK,�
Signature of Notary Public L
o`"•P ''4', 7GNIGINDLESPERGER [ ] Personally Known OR [ ] Produced Identification
• "1 MY COMMISSION#GG 353178
_•.��,:. Type of Identification:
EXPIRES: er 6,2023.
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