315 11TH ST 2015 PLUMB CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
—" ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
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PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-PLBG-637
Job Type: PLUMBING ONLY
Description: 2 FIXTURES
Estimated Value:
Issue Date: 3/18/2015
Expiration Date: 9/15/2015
PROPERTY ADDRESS:
Address: 315 11TH ST
RE Number: 170099-0000
PROPERTY OWNER:
Name: BURBRIDGE, DAVID & SHANNON,
Address: 315 11TH ST
GENERAL CONTRACTOR INFORMATION:
Name: COURTESY PLUMBING INC
Address: 1205 LAMANTO AVE WILLIAM TRAVIS GLASS
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $14.00
Trade Permit Base Fee $55.00
Total Payments: $73.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
_ Ph(904 4 -5826 F (904) 247-5845
JOB ADDRESS: ,� I r L<� PERMIT#
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NEW OR REPLACEMENT INSTALLATION: Project Value$ v
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 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 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 aut to�vio)lat the pr agons of aq other st to or local law regulation construction or the performance of construction.
Property Owners Name Phone Number
07V
Plumbing Company L� +e Office Phone
Co. Address: i City7:7
Stat ip
State Certification/Registration
License Holder(Print): # 7 7
01
Not t r i n Holder
Notary Public State of Florida efore me this 20
Shirley L Graham
4 My Commission FF 086990
no�0 Expires 02/14/2018 ignature of Notary Pu
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