675 BEACH AVE PLUMBING 'tI
�S CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
U9�
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-PLBG-571
Job Type: PLUMBING ONLY
Description: 7 fixtures
Estimated Value:
Issue Date: 3/12/2015
Expiration Date: 9/8/2015
PROPERTY ADDRESS:
Address: 675 BEACH AVE
RE Number: 170121-0000
PROPERTY OWNER:
Name: BENZ, JAMES W&CATHERINE M,
Address: 675 BEACH AVE
GENERAL CONTRACTOR INFORMATION:
Name: COGBURN AND WAKEFIELD PLBG
Address: 5900 TOWNSEND BLVD APT 522 QA JOHN COGBURN
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $49.00
Trade Permit Base Fee $55.00
Total Payments: $108.00
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
Ph2(904) 247-5826 Fax (904)247-5845 f, /
JOB ADDRESS: ( � [ ( c9A,-- i GU4C PERMIT# 15-- kST )7S
NEW OR REPLACEMENT INSTALLATION: Project Value sL-1 00.�
TYPE oFFixTURE QTY TYPE oFFIXTURE 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 1 Urinal
Kitchen SinkJ_ Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory I Water Heater —j—
Other Fixtures Water Treating System
RE-PIPE:
TYPE of F/XTuRE QTY TYPE oFF7XTURE 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 tine 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�provisionslof any otherN,gtime or local law regulation construction or the performance of construction.
Property Owners Name ,')65cp fj(/,ci�ct (ly� I.e�- / ��"'Z Phone Number 2ql- 03ZO
Plumbing Company �tjA� 4- WnL�e IeL Qjj, St Office Phone S-27- I00 Fax 379 -foo3l
Co. Address: City ZDA X State F�— Zip ?22 to
License Holder(Print): 6 kA h'J A?-+ S to Certification/Registration it
Notarized Signature ofLicense Holder
Before me thdrl6w 20
Signature of Notary Public