102 SANDY BCH LN PLUMB J
I' ll , CITY OF ATLANTIC BEACH
j 800 SEMINOLE ROAD
J X 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-852
Job Type: PLUMBING ONLY
Description: 10 FIXTURES
Estimated Value:
Issue Date: 4/14/2015
Expiration Date: 10/11/2015
PROPERTY ADDRESS:
Address: 102 SANDY BEACH LN
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: ADVANTAGE PLUMBING
Address: 880 MAYPORT RD QA GREG GAUSE
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.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845
.TOB ADDRESS: /G S PERMIT
NEW OR REPLACEMENT INSTALLATION: Project Value
TYPE OF FIXTURE QTY TYPE OF FIXTURE QT'
BathtubSeptic Tank&Pit
Clothes Washer 4— 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
RE-PIPE: /
TYPE OF FIXTURE QTY TYPE of FIXTURE QTY
Bathtub Septic Tank&Pit
Shower
Clothes Washer
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Three Compartment Sink
Floor Drain
Toilet
Floor Sink
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS: gallons(Requires 3 sets of plans)
❑ Sewer Replacement El Back Flow Preventer ❑ Grease Interceptor(Trap) g
❑ Lawn Sprinkler System Number of Heads ❑ Well
** SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ Other
month period or work or
onths.I hereby
that I have
Permit becomes void if work does not commence
thincorrect six AIl p ovisio s of laws and ordinancesc dgoveri ring this for
ill be complied w ithmi certify
specified
this application and know the same to be true
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.
Phone Number
property pe Owners Name
Office Phone��7"
Plumbing Company 2�
City r �3 G State Zip �_3
Co. Address:
License Holder(Print): !J �' S Certification/Registration#
Notarized Signature of License Holder 20/6
Sworn and subscribed efore me s �y of
! Notary Pudic State of Florida
Kim Sandberg Si ature of Notary Publi
My Commission FF 164674
%o' Expires 09/30/2018