1777 Beach Ave 2014 Plumb CITY OF ATLANTIC BEACH
_ f 800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
PLUMBING PERMIT INSPECTION PHONE LINE 247-5814
r CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMA N:
o - -
Job Type: PLUMBING ONLY
Description: INSTALL 3 FIXTURES
Estimated Value:
Issue Date: 10/9/2014
Expiration Date: 4/7/2015
PROPERTY ADDRESS:
Address: 1777 BEACH AVE
RE Number: 169676-0000
PROPERTY OWNER:
Name: ANDREWS, LEE
Address: 853 QUEENS HARBOR BLVD
GENERAL CONTRACTOR INFORMATION:
Name: CUSTOM PLUMBING AND TILE
Address:
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $21.00
Trade Permit Base Fee $55.00
Total Payments: $80.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PERMIT APPLICATION
1 ATLANTIC BEACH
Rd Atlantic Beach, FL 32233
-5826 Fax (904) 247-5845 i 1���
CIT;' OF ATLANTIC BEACH PERMIT#`O.r'� l� w
JOB, 800 SEh1Ii•1GLE ROAD "---ff
ATLANTIC BEACH, FL 33E33
PHONE (904j Z47-5955
NEVA Project Value$ yob
Job ID; TYPEoFFIXTURE QTY
Job ID: 14-PLBG-180 - INSTALL 3 FIXTURES
Job 1D: Septic Tank&Pit
t; Shower
106 ID; 14-
PLBG-i8O - INSTAL` 3 FIXTURES Shower Pan
.lob 1D: Slop Sink
Job ID: 14-PLBG-180 - INSTALL 3 FIXTURES Three Compartment Sink
Toilet
Job ID: Urinal
Job ID: 14-PLBG-180 - INSTALL 3 FIXTURES Vacuum Break
Tender Details: Cash $80.0o Water Co
Tender Type: CC Wat
Tender Amount: $00.00 NAT -
Receipt Header:
Cashier Id: aspcust\atibbja
RE- Receipt Date: 10/8/2014
Receipt Number: OS-65307 ` �(
Bathtub
Clothes Washer
Dishwasher
Drinking Fountain
Floor Drain
Floor Sink 6 C
Hose Bibs
Kitchen Sink
Laundry Tray
Lavatory
Other Fixtures
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Inter gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ P **
**SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ Other AzeW Z /N -V-h{D 4�? o2i(d g"11-
Permit
"/✓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 Phone Number
Plumbing Company �'�`IXY� V- t t Office Phone Fax
Co. Address: City State Zip
License Holder(Print)Y/l L State Certification/Registration# �✓V2 7M3
Notarized Signature of License Holde
EEW.
JENNIFER WALKERBefore me this da 20MY COMMISSION Y FF Ri 14d0EXPIRES:April 24,201 Signature of Notary Public I AraBonded Thr.Nota Public Undenvdlers