381 4TH ST 2015 PLUMB -S! ,\ J.
r CITY OF ATLANTIC BEACH
J -
if 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: 15-PLBG-237
Job Type: PLUMBING ONLY
Description: 12 fixtures
Estimated Value:
Issue Date: 1/29/2015
Expiration Date: 7/28/2015
PROPERTY ADDRESS:
Address: 381 4TH ST
RE Number: 169846-0000
PROPERTY OWNER:
Name: BARTLESON, PATRICIA
Address: 381 4TH ST
GENERAL CONTRACTOR INFORMATION:
Name: F.W. FAIR PLUMBING CO.
Address: P O DRAWER 51558 QA FRED FAIR
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $84.00
Trade Permit Base Fee $55.00
Total Payments: $143.00
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: / / �� 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 QTS'
Bathtub �i Septic Tank&Pit
Clothes Washer �— Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor SinkToilet
Hose Bibs �— Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances '
Lavatory _ Water Heater
Other Fixtures Water Treating System I�
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 y other state or local law regulation construction or the performance of construction.
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Phone Number 0 �" 0 3
Property Owners Name _
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Plumbing Company � A ) -
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Co. Address:
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License Holder (Print):
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Notarized Signature of License Holder
Sworn and subscrib e me this d f 20
Signature of Not Publi