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1325 BEACH AVE PLRS21-0010 - :.„„ ;, Plumbing Permit Application **ALL INFORMATION HIGHLIGHTED IN ii ')• City of Atlantic Beach Building Department GRAY IS REQUIRED. 800 Seminole Rd, Atlantic Beach, FL 32233 PLR -Z. ( — Co I 0 ,.,isEY Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#: JOB ADDRESS: ISQVIA 't-�"v PROJECT VALUE $/PAO . 7.,_0-014 ❑NEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY Bathtub I Septic Tank& Pit Clothes Washer Shower Dishwasher Shower Pan 2 Drinking Fountain Slop Sink Floor Drain Three Compartment Sink Floor Sink Toilet 3 Hose Bibs Urinal Kitchen Sink Vacuum Breakers Laundry Tray -- Water Connected Appliances Lavatory It Water Heater —)— Other Fixtures Water Treating System ❑MISCELLANEOUS ❑ Sewer Replacement 14 ❑ Back Flow Preventer ❑ Lawn Sprinkler System (number of sprinkler heads) ❑ Grease 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: hvVrtil1"J V►4I,l Phone Number: cirft-m—(05(ci, Plumbing Company: WthAV / Office Phone: orot_%-rir-dd, Fax Co. Address: l . syv t F I� City: Cr Ak\ State:' Zip: ?iti6 License Holder: ►i A.,v,a4AI State Certification/Registration # Notarized Signature of License H. der The forego) strumennt w s acknowledged before me this (c-1d of, 0./A , 2I?--- (, in the State of Florida, County of UV�1 Signature of Notary Public.- c ,=o'•RC•P• �. TONI G:NDLESPERGER [ ] Personally Known OR [ ] Prodyced Identification *; '•, •:,: MY COMMISSION#GG 353178 (....- -,°=,;:;.74.-...,;:z77. EXP,RES:October 6,2023 Type of Identification: J "-`� '��, onded Thru Notary Public Underwriters !_ Updated 10/17/18