152 3RD ST PLUMBING CITY OF ATLANTIC BEACH
' 800 SEMINOLE ROAD
;a 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-960
Job Type: PLUMBING ONLY
Description: 25 FIXTURES
Estimated Value:
Issue Date: 4/24/2015
Expiration Date: 10/21/2015
PROPERTY ADDRESS:
Address: 152 3RD ST
RE Number: 170196-0000
PROPERTY OWNER:
Name: ANDD, STEPHANIE ELIZABETH
Address: 152 3RD ST
GENERAL CONTRACTOR INFORMATION:
Name: COGBURN AND WAKEFIELD PLBG
Address: 5900 TOWNSEND BLVD APT 522 Q4 JOHN COGBURN
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $175.00
Trade Permit Base Fee $55.00
Total Payments: $234.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax(904)247-5845
JOB ADDRESS: I JroZ 3t-A -54- PEIRMIT# I5--90D-313
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OFF/XTURE 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 S`Y
Other Fixtures Water Treating System n
RE-PIPE: v
TYPE oFFIXTURE QTY TYPE OF FIXTURE Q
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 **
**SIRWD 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 some to be one 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 some or local law regulation construction or the performance of cunmuclion.
Property Owners Name hone Number 7 41- 02-0
Plumbing Company 1 'vcles e.o 4- td PJuAb11A Office Phone 52'�- t420 Fax 379-Lo31
Co. Address: D o 5. City \A t( State FL Zip 322 10
License Holder(Print): d" t_L+kiQ - State Certification/Registration# CFC lqz Bl`O
Notarized Signature of License Holder
Before me this day of 20
Signature of Notary Public