174 JACKSON PLBG �s '� l S, CITY OF ATLANTIC BEACH
f 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
30B INFORMATION:
lob ID: 14-PLBG-540
]ob Type: PLUMBING ONLY
Description: 3 fixtures
Estimated Value:
Issue Date: 12/3/2014
Expiration Date: 6/1/2015
PROPERTY ADDRESS:
Address: 174 JACKSON RD
RE Number: 172146-0000
PROPERTY OWNER:
Name: MILLER, DANERI WILLIAMS
Address: 174 JACKSON RD
GENERAL CONTRACTOR INFORMATION:
Name: ADVANTAGE PLUMBING
Address: 880 MAYPORT RD QA GREG GAUSE
_ 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: $80.00
PEI MIT
IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BU
LDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904) 247-5826 Fax(904)247-5845
JOB ADDRESS: PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
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
Mose 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 Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water 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 beco es 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 Namef�/.�/f�9 fp Phone Number
Plumbing Company
Office Phonee2 V7-2' �� Fax
7 1
City /�� 13 — State Zip 3Z2�3
Co. Address: D
License Holder(Print): U �� State Certification/Registration#f
L'
Notarized Signature of License Holder
Sworn and subscribed before me 's day o20
fZIE
l�
JULIE YOUNG CHRISTY
1� MY COMMISSION#FF OM5
a• EXPIRES:July 21,2017 Signature of Notary Public
•° Bonded Thru Notary Public Underwriters