346 SEMINOLE RD PLRS21-0108 Plumbing Permit Application **ALL INFORMATION
HIGHLIGHTED IN
City of Atlantic Beach Building Department GRAY IS REQUIRED.
800 Seminole Rd, Atlantic Beach, FL 32233
Phone: (904) 247-5826 Email: Building-Dept@coab.us PERMIT#:I- S
L� 2(— Ol OF
JOB ADDRESS: '1-(it. 5c./.tt,,Lil 14 &'rl, 1-141 44taic 13c [ 1I rI PROJECT VALUE $ .SIG-So .(10
ESJEW OR REPLACEMENT INSTALLATION and/or DRE-PIPE
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank & Pit
Clothes Washer Shower 2
Dishwasher 1 Shower Pan 1
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs _ Urinal
Kitchen Sink 1 Vacuum Breakers
Laundry Tray 1,_ Water Connected Appliances
Lavatory Water Heater
Other Fixtures / Water Treating System
❑MISCELLANEOUS I
❑Sewer Replacement
DBack 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
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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:Christopher M. Flores Phone Number: (904) 885-2981
Plumbing Company: Tactical Plumbing Inc. Office Phone: (904)962-4779 Fax
Co. Address: 595 Ashcroft Landing Dr City: Jacksonville State: FI Zip: 32225
License Holder: Christopher M. Flores ,i State Certification/Registration # RF11067624
Notarized Signature of License Holder 7- • i-� � - ------
The foregoing instrument was acknowledged before me this 10 day of 20 2/, in the State of Florida,
County of --L- JL4\ (
- /
.:4.- • BRITTNEY CRAWFORD ( i i ,i---
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: '� �-. Notary Public-State of Florida I Signature of Notary Public t! _ � L(.
klits`r Commission#GG 351609 —�
,_,,,,,,,e• My Comm.Expires Jul 4,2023
Bonded through National Notary Assn. I ,[Personally Known OR [ 1 Produced Identification
Type of Identification:
Updated 10/17/18