178 Pine St 2014 plumb repipe its CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
•j � ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
ht
Application Number . . . . . 14-00000476 Date 3/28/14
Property Address . . . . . . 178 PINE ST
Application type description PLUMBING ONLY
Property Zoning . . . . . . . TO BE UPDATED
Application valuation . . . . 0
Owner Contractor
_
_ ------------------------
JONES, RUSSELL A & ELIZABETH WILLIAM' S BIG BOY PLUMBING INC
380 GARDEN LANE 516 SOUTH 11TH AVE
ATLANTIC BEACH FL 32233 JACKSONVILLE BEACH FL 32250
(904) 241-1880
------------------------------------------
Permit . . . . . . PLUMBING PERMIT
Additional desc . . . 00
Permit Fee . . . . 125 . 00 Plan Check Fee
Issue Date . . . . Valuation . . . . 0
Expiration Date . . 9/24/14
---------------------
-----------------------------
Other Fees . . . . . . . . . STATE PLBG DCA SURCHARGE 2 . 00
STATE PLBG DBPR SURCHARGE 2 . 00
----------------------------------------------------------------------------
Fee summary Charged Paid Credited Due
----------------- ----------
---------- --
Permit Fee Total 125 . 00 125 . 00 . 00 . 00
Plan Check Total . 00 . 00 . 00 . 00
Other Fee Total 4 . 00 4 . 00 . 00 . 00
Grand Total 129 . 00 129 . 00 . 00 . 00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904) 247-5845
JOB ADDRESS: Pkr- Q (% - PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
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 Water Heater
Other Fixtures Water Treating System
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 1 Urinal
Kitchen Sink Vacuum Breakers
Laundry TrayWater Connected Appliances
Lavatory —� Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ 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.
Property Owners Name
d� ``100V?5 rel
Phone Number
Plumbing Company W c1�t LZI, �9 t 6w Office Phone 2 qt— ** Fax
Co. Address: 5- 1 �'�V�� City Jaw 6,L. State 7 Zip 322S Z?
License Holder(Print): I l� �• LIw State Certification/Registration#�t'�LP/p70
Notarized Signature of License Holder
Before me this qday of elK 20
Signature of Notary Public Ink