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383 3RD ST 2015 PLUMB CITY OF ATLANTIC BEACH 800 SEMINOLE ROAD ATLANTIC BEACH,FL 32233 PLUMBING PERMIT MUST CALL BY 413M FOR NEXT DAY INSPECTION: 247-5814 JOB INFORMATION: Job ID: 15-PLBG-867 Job Type: PLUMBING ONLY Description: 2 FIXTURES Estimated Value: Issue Date: 4/15/2015 Expiration Date: 10/12/2015 PROPERTY ADDRESS: Address: 383 3RD ST RE Number: 169825-0100 PROPERTY OWNER: Name: GAJEWSKI,THADDEUS J & MARIANNE, Address: 383 3RD ST GENERAL CONTRACTOR INFORMATION: Name: STEVE REESE PLUMBING Address: P O BOX 26397 JKVL FL 32226 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)J247-582x6 Fax (904) 247-58845 JOB ADDRESS: 3 -7_4 rea'0 5 ` PERMIT# v�— 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 ��+Qf° _ 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 authority to violate the provisions of any other state or local law regulation construction or the performance of construction. Property Owners Name a .� 1 Phone Number PlumbingCompany � ^n . rrpne" � Office Phone ax 7 S'7 pis Co. Address: 1�-'!F' /5f l�- a' City State,7Vv Zip License Holder(Print) to Certification/Registration# CrI-U Notarized Signature of License Holder Before me this day of 20 Signature of Notary Public