1743 E Park Ter 2015 Plumb s CITY OF ATLANTIC BEACH
J
Is1
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-602
lob Type: PLUMBING ONLY
Description: 10 fixtures
Estimated Value:
Issue Date: 3/17/2015
Expiration Date: 9/13/2015
PROPERTY ADDRESS:
Address: 1743 E PARK TER
RE Number: 172020-0408
PROPERTY OWNER:
Name: FULLER, ELZER T JR
Address: 1743 PARK TER
GENERAL CONTRACTOR INFORMATION:
Name: DAVID KOUTZ LLC
Address: 1219 THE GROVE RD DAVID ANTHONY KOUTZ
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $70.00
Trade Permit Base Fee $55.00
Total Payments: $129.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
Mar 08 10 12:54p
Information SystemsCFiY 0 904247-5845 P•1
PLUMBING PERNUT APPLICATION
CITE' OF ATL `ic BEACH
S00 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5825 Fax(904)247-5545
JOB A )DRESS' P3ERmfI'
l ..
NEW OR REPLACEMENT INSTAL LATT()N: Project Value $
;1!'YPE O�ti'FIX7'CiR.E
( TY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit
Shover
Clothes Washer
Dishwasher Slop Shower Pk
LinkThree
Linking Fountain ink
Floor Drain Three compartment Sink .
Toilet
Floor Sim -- Urinal
Hose Bibs Vacuum Bre4=rs
Kitchen Sink Nater Connected Applian=s
Laundry Tray Nater Heater
Lavatory Water Treating System
Diher Fixiva'es
RE-PIPE;yy�p�1G s
`r-PE aF FDOZ—' QTY T'YFE OF F'LU-U;?E QTY
Bathtub 2 Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
S Lop
Thr
DrinlQn.o Fountain Thr Sink
ee compartment Sink �
Floor Dram Toilet
Floor Sink �_ Ural
Hose Bibs �_ Vacuum.Break
Kitchen Sink Water Connected Appliances
Laundry T M �_ Wates'Heater --�---
Lavatory Vat=Treating System
Other Fimtures
TvUSCEI LANEOUS: lons(Requires 3 sets Of per)
❑ Sewer Replacement ❑ Back Flow Perventer ❑ Grease Interceptor(Trap)
Lawes Sprinkler system T-7nniber of�Heads ❑ Neil *T
I SIRED Well Campletifl,z Farm. Completed form to be submitted to ti=e Building Department for final ins pection.**
❑ Other
Permit becomes void if work does not eatnmence within a six month period or work is suspended cr�anin cruor will complied theT- d
this application and know tele same to be true and correct. All provisions of laws and ordinances go
or noL The permit does-not give autbOritY to viola!+the provisions of any other state or local IwN regulation cons=ctkm or the performance of eor3struc:ion.
Phone Naber
Proper+-y Owners Dame .11
1�36 �'r v Plumbing, Inc. o��e Phone � »_,< Fax_-7 .
Fl��*-ibing Carnparzg :�:.,ot,.are uoU�
813 0 1 {3Ck Or ;t' City State Zip
Co. Address: �__� ._ `.:, �'`_ ,`:� y^{
License l$o�rle� 'ri�t)• 1� '��;?-� State Certif caiionfRegis#ration C r� t�1-
Sworn and subscril od before tae this I&&_day of kkarC.L 20�
Signage of Notary Public &)�tQ(ia CA. L�
,.so PQ. Notary Public State M Florida
LaSheica Wilson
My Commission FF 180366
% Expires 01/04/2019