1964 BEACHSIDE CT PLUMBING CITY OF ATLANTIC BEACH
j 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
JOB INFORMATION:
Job ID: 15-PLBG-936
Job Type: PLUMBING ONLY
Description: 8 fixtures
Estimated Value:
Issue Date: 4/22/2015
Expiration Date: 10/19/2015
PROPERTY ADDRESS:
Address: 1964 BEACHSIDE CT
RE Number: 169542-0586
PROPERTY OWNER:
Name: CARNES, DARCY S
Address: 1964 BEACHSIDE CT
GENERAL CONTRACTOR INFORMATION:
Name: B & G PLUMBING, HEATING &
Address: 1729 E DIBBLE CIR SCOTT MARTIN
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $56.00
Trade Permit Base Fee $55.00
Total Payments: $115.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax (904) 247-5845
TOB ADDRESS: I q(A L4 PERMIT#
,;EW O REPLACEMENT STALLATION: Project Value$
FUTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic:Tank&Pit
Clothes Washer Show-,r-
Dishwasher 1 Show-,r Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet: i
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 3 Water Heater �-
Other Fixtures Water Treating System
RE-PIPE:
TYPE OF FIXTURE OTY TYPE'OF FIXTURE OTY
Bathtub Septic.Tank&Pit
Clothes Washer Show er
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Threes Compartment Sink
Floor Sink Toilet
Hose Bibs UrinEl
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 suspenlied 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 ordirances 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 Phone Number
Plumbing Company -_Office Phone X73-a S$�� Fax J,7a-a>So
Co. Address: OUa- 1�LL)d City 40-J%6oa u,.t to State F l Zip a ZU6
License Holder- (Print): a-e-.•c. a. yLou c! e rtificatioii/Registration#
Notarized Si,,gnature of License Holder �L-
Sworn and subscribed before me:this day of 20
Signature of Notary Public