363 Atlantic Beach Unit 9 PLPP21-0023 App Plumbing Permit Application **ALL INFORMATION
ALL INFORMATION
A
4,17::ft
City of Atlantic Beach Building Department GRAY IS REQUIRED.
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VIP800 Seminole Rd, Atlantic each Beach, FL 32233 Pi,ppZ1 - 00
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
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JOB ADDRESS: 3 63 , 7GA'- 77 4477i7�' Pt 'Z2 ) PROJECT VALUE $ 5 2Z7
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mNEW OR REPLACEMENT INSTALLATION and/or El RE-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 __2_ Water Heater /
Other Fixtures Water Treating System
Ill MISCELLANEOUS
❑ Sewer Replacement
❑ 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 regulationc ruction or the performance of construction.
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Owner Name: �Z/7�ILyy� A-14-1J Phone Number: OV.---)/e/'Of‘)
Plumbing Company:f/YIMO US F/e141.4//y/ Office Phone: *-)/YV-33-9-
Fax
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Co. Address: City: State: 1 Zi
License Holder:ibikez.2 , , , S ate Certif. ion,4;egistration # f/O6 7,310/
Notarized Signature of License Holder / / /
The foregoing instrument was acknowledged before me this T7 day of 3 tl iv E , 20 2.1 , in the State of Florida,
County of 0UY14L
- ►41,_0' I Signature of Notary Public 7/ll/ //t A'LA
't%"�' CHRISTIAN GILES
-, ..y4 ,, MY COMMISSION#HH 117153
o nderwdlers [ ) Personally Known OR [ roduced Identification
."4.:"" EXPIRES:April 13,2025 �_
Fo::•�.• Bonded rn„rN,b,yp,r Type of Identification:
Updated 10/17/18