353 5th St 2014 Plumb �,,1j\
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J
J ATLANTIC BEACH, FL 32233
PLUMBING PERMIT INSPECTION PHONE LINE 247-5814
ALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job - -
Job Type: PLUMBING ONLY
Description: SEWER REPLACEMENT
Estimated Value:
Issue Date: 9/23/2014
Expiration Date: 3/22/2015
PROPERTY ADDRESS:
Address: 353 5TH ST
RE Number: 169868-0000
PROPERTY OWNER:
Name: HORTON, JOHN W
Address: 345 4TH ST
GENERAL CONTRACTOR INFORMATION:
Name: TDG PLUMBING
Address:
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $7.00
Trade Permit Base Fee $55.00
Total Payments: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-5845
.TOB ADDRESS: S '5Trr- K7 PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
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 oFFIXTURE QTY TYPE oFFIXTURE 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
MISCE NEOUS:
.P-Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
of Heads ❑ Well
❑ Lawn Sprinkler System-Number *
p
** SJR WD 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 ,1 O r h Phone Number
Plumbing Compan7 — Q LyM" �'''�9 Office Phone SN ;-_7?2NI Fax
Co. Address:LN,.k- City State Zip
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License Holder(Print) f
Notarized Signature of License Holde+r,,�� ++yy,
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Notary"W Me��-iAls f20Shirley L Graham
MMC �@�No ry PublicExpires t