306 12TH ST. PLBG PERMIT CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 14-PLBG-581
Job Type: PLUMBING ONLY
Description: new water service
Estimated Value:
Issue Date: 12/8/2014
Expiration Date: 6/6/2015
PROPERTY ADDRESS:
Address: 306 12TH ST
RE Number: 171923-0000
PROPERTY OWNER:
Name: TOUSEY JR, CLAY B & PHYLLIS,
Address: 2225 ALICIA LN
GENERAL CONTRACTOR INFORMATION:
Name: CUSTOM PLUMBING AND TILE ELBLACKBURN
Address: 2742 SETTLEMENT DR QA THOMAS MICHA
Phone:
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $161.00
Trade Permit Base Fee $55.00
Total Payments: $220.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: _W14- g-7- PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE oF FixTvRE 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 ShowerPan
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
L US:
rSettp1=%n?t El Back Flow Preventer o Grease Interceptor(Trap) gallons(Requires 3 sets of p a s)
Ei Lawn Sprinkler System-Number of Heads El Well
** SJR WD Well Completion Form. Completed—forrn to be submitted to the—Building Department for final inspection.
Ei 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.
Phone Number
Property Owners Name -fotetC-!�K-r
Plumbing Company e4rSAm 10%WKL,�6 -ZlAe ro�,,C Office Phone %(/--J&v-WS"Tax
Co. Add�ess: 27 2. City J�1-Isc - State"rl zip S2 2 2
License Holder(Print): ffW&&C &Cz� State Certification/Registration# CFC
Notarized Signature of License Holder (Z3 2-�K
Before me this day of 20
Signature of Notary Public