1711 sea oats Dr 2015 Plumb rjr,Jlr
CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
j ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
]OB INFORMATION:
Job ID: 15-PLBG-177
Job Type: PLUMBING ONLY
Description: SEWER REPLACEMENT
Estimated Value:
Issue Date: 1/26/2015
Expiration Date: 7/25/2015
PROPERTY ADDRESS:
Address: 1711 SEA OATS DR
RE Number: 172020-0440
PROPERTY OWNER:
Name: KROUCH, CARL W
Address: 1711 SEA OATS DR
GENERAL CONTRACTOR INFORMATION:
Name: ROTO ROOTER SERVICES
Address: 2028 W 21ST ST QA ROBERT VINCENT FARR
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
Plumbing Fixtures $7.00
Trade Permit Base Fee $55.00
State PLMG DCA Surcharge $2.00
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
JOB ADDRESS: t- E-Eil 0 A+{- J V?—' . 324-4- 3 PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value $ -no °v
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub ' Septic Tank& Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Still(
Floor DrainThree Compartment Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures .5jr �_ Water Treating System
RL-PIPE:
TYPE OF FIXTURE QTY TYPE OFF'IXTURE 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
M SCELLANEOUS:
Xewer 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 any other state or local law regulation construction or the performance of construction.
Property Owners Name0f�21 K�d Phone Number �'� -c��
Plumbing Company L)+-R 1,C'e S e- 0 Office Phone3Pi- 73 21 FaN?'�_Lr-YZSS
Co. Address: '�20 �t t 6'+ City �U .� 6f_ State EL Zip ZZ.O
License Holder (Print): State Certification/Registration#CFC.��1`ti!39'
Notarized Signature ofLicense Holder
[j�ptate of Florida worn and subscribed before me this vZ CP day of 20 ).5
eizern EE106301 0 1 5 gnature of Notary Public