1600 Selva Marina Drive 16-PLBG-1405 (Plumbing) `CA CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
7.510 ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 16-PLBG-1405
Job Type: PLUMBING ONLY
Description: PLUMBING - 22 FIXTURES
Estimated Value:
Issue Date: 6/17/2016
Expiration Date: 12/14/2016 _
PROPERTY ADDRESS:
Address: 1600 SELVA MARINA DR
RE Number: 169399-0000
PROPERTY OWNER:
Name: ATLANTIC BEACH PARTNERS, LLC
Address: 414 OLD HARD RD SUITE 502
GENERAL CONTRACTOR INFORMATION:
Name: AMERICAN PLUMBING CONTRACTORS
Address: 5720 ARLINGTON RD QA RANDOLPH EROL MILLER
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $154.00
Trade Permit Base Fee $55.00
Total Payments: $213.00
PERT11T IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
i
PLUMBING PERMIT APPLICATION
_ CITY OF ATI ANTIC-REACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904)247-5845 1 - PLBe- t 4 05
JOB ADDRESS: / &) SC2`id 4 m A ,-14/11- 1) R , PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
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 I
Floor Sink ,- Toilet a
Hose BibsUrinal I
Kitchen Sink Vacuum Breakers
Laundry Tray —M. Water Connected Appliances
Lavatory ater Heater -7--
Other Fixtures
41/
ater Treating System
RE-PIPE: 1J
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 Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
o Sewer Replacement 0 Back Flow Preventer 0 Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads 0 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.
Property Owners Name ?G/1 N `(34.,7t L - ' 11y G'ohPhone Number
Plumbing Company R m e/ "-/T'11 V ni /i .;� Office Phone ' s/613 Fax
Co. Address: _,,c-?6,2L) f N.-iii). 7 City } State P6 Zip, ?a. //
License Holder(Print): A A 'IIP�P +- We/ ate Certification/Registration# (PC C i $/5(f
Votarized Signature of Licens" older /
- 1oreore me this )7day of U !1 20
mets
DLESPERGERION 1 FF 924951 Si nature of Notar Public `
ctoberF 2019 y nary Public Underwriters