371 8TH ST PLUMBING -s'
CITY OF ATLANTIC BEACH
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 INFORMA77ON:
Job 10: 15-PLBG-891
Job Type: PLUMBING ONLY
Description: 2 FIXTURES
Estimated Value:
Issue Date: 4/16/2015
Expiration Date: 10/13/2015
PROPERTY ADDRESS:
Address: 371 8TH ST
RE Number: 169975-0000
PROPERTY OWNER:
Name: WOOD, JEREMY B
Address: 371 8TH ST
GENERAL CONTRACTOR INFORMATION:
Name: TDG PLUMBING
Address: 4426 LOYS DR QA TRAVIS DALE GAINEY
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: $73.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
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Ph(904)247-5826 Fax(904)247-5845
JOB ADDRESS: 3^[ ' pp TL- JTrcit PERMIT#/S^ G2
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE of FLYTORE QTY TYPE OFFLYTURE QTY
Bathtub — Septic Tank&Pit
Clothes WasherShower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Sink
Floor Drain Three Compartment Sink
Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum Breakers
Laundry Trey Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
RE-PIPE:
TYPEOFF1xTuRE QTY TYPE OFF7xTORE 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 ««
**S7RWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
❑ Other (:)an216e SlAovt(
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 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 state or local law regulation construction or the performance ofoonstruclion.
Property Owners Name Phone Number
Plumbing Company 1 G PL�w..bi+_T_ _Office Phone S'LIS"")'J4) Fax "4
Co. Address:LJ�Qt_ Lov.% OR City'SA1F State Zip ,124�.
License Holder(Print):^Ta Aa. r-A%ne State Certification/Registration#CVC^ (L{2-)062.
Notarized Signature of License Holder
Before me this day of 20
Signature of Notary Public