Loading...
PLRS21-0088-- r Plumbing Permit Application City of Atlantic Beach Building Department 800 Seminole Rd, Atlantic Beach, FL 32233 Phone: (904) 247-5826 Email: Building-Dept@coab.us JOB ADDRESS: 51 Beach Ave Atlantic Beach FI 32233 ENEW OR REPLACEMENT INSTALLATION and/or EIRE -PIPE TYPE OF FIXTURE Bathtub Clothes Washer Dishwasher Drinking ::ountain Floor Drain Floor Sink Hose Bibs Kitchen Sink Laundry —ray Lavatory Other Fixtures ❑VIISCELLANEOUS *ALL INFORMATION HIGHLIGHTED IN GRAY IS REQUIRED. PERMIT #: RES19-0058 PROJECT VALUE $ 80,000.00 QTY TYPE OF FIXTURE QTY 1 Septic Tank & Pit 2 Shower 7 1 Shower Pan Slop Sink Three Compartment Sink Toilet 9 6 Urinal 3 Vacuum Breakers 3 Water Connected Appliances 3 9 Water Heater 4 Water Treating System 1 ❑Sewer Replacement ❑Back Flow Preventer ❑ Lawn Sprinkler System (number of sprinkler heads) 03rease Interceptor (Trap) gallons (Requires 3 sets of plans) Well ** SJRWD Well Completion Form. Completed `o -m 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 constructior or the performance of construction. Owner Name: Robin Sorensen Phone N.Amber: Plumbing Company: Betos Plumbing Contractors Office Phone: (904) 683-1968 Fax (904) 647-8425 Co. Address: 5215 Highway Ave Suite 102 city: Jacksonville State: Florida zip: 32254 License Holder: Stephen M Betr©s State Certification/Registration # CFC1428972 Notarized Signature of License Holder The foregoing instrument was acknowledged before me this 16r day of 3WIL , 202-1 , in the State of Florida, County of 0 V**4ft4- Signature of Notary Public V,(-- L4 [personally Known OR [ ] Produced Identification Type of Idertification: Updated 10/17/18 o% f nrti Notary publ1c State of Florida Ken W Kilpatrick My Comm scion GG 757818 Expires rt1o212022 Signature of Notary Public V,(-- L4 [personally Known OR [ ] Produced Identification Type of Idertification: Updated 10/17/18