334 N Oceanwalk Dr PLRS19-0204 App �,. ,-,,,• �"�,• , Plumbing Permit Application "ALL INFORMATION
"• HIGHLIGHTED IN
` °' City of Atlantic Beach Building Department GRAY IS REQUIRED.
/ 800 Seminole Rd, Atlantic Beach, FL 32233 r i_R c l - (31 c -
'''• Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:
JOB ADDRESS: 334 Oceanwalk Drive North Atlantic Beach FL 32233 PROJECT VALUE $12.40CC
['NEW OR REPLACEMENT INSTALLATION and/or ORE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE (21Y
Bathtub Septic Tank& Pit
Clothes Washer I Shower
Dishwasher I Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs
___.4___ Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray Water Connected Appliances /
Lavatory Water Heater t i! .IAI)Other Fixtures Water Treating System /
DVIISCELLANEOUS \
❑Sewer Replacement I A❑Back Flow Preventer 4' "- v
❑Lawn Sprinkler System (number of sprinkler'heads) . �i•.'
D3rease Interceptor (Trap) gallons (Requires 3 sets of plans)
El 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.Shannon Heyward Phone Number: (904) 502-0366
Plumbing Company: renwick Plumbing Office Phone: (904) 724-7022 Fax(904) 724-8869
Co. Address: 11623 Columbia Park Drive E City: Jacksonville State: FI Zip: 32258
License Holder: Bill Fenwick Jr. 42 ate Cert Ica n/Registration # CFC040039
Notarized Signature of License Holder
The foregoing instrument was acknowledged before me this l' day of - 1 12-, 20_I , in the State of Florida,
County of 1 '\.,, 4 ALA
V,C.fil , C r
i ,: .,,44,:i ALEXANDRIA ACOSTA Signature of Notary Public! s1( ') ,_�i�
, 4'.
I'•; MY COMMISSION#GG090381
EXPIRES WI 04.2021 [Personally Known OR ( ] Produced Identification
i '1t''1'• "type of Identification:
Updated 10/17/18