300 5TH ST PLUMBING 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
306 INFORMATION:
lob ID: 15-PLBG-531
lob Type: PLUMBING ONLY
Description: REPLACEMENT 2 FIXTURES
Estimated Value:
Issue Date: 3/10/2015
Expiration Date: 9/612015
PROPERTY ADDRESS:
Address: 300 5TH ST
RE Number: 169827-0500
PROPERTY OWNER:
Name: JERNAGAN III, LOUIS R & HOPE V,
Address: 300 5TH ST
GENERAL CONTRACTOR INFORMATION:
Name: HARRY L HAYES PLUMBING INC
Address: 6837 OAKWOOD DR HARRY L HAYES
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
PER� IS APPROVED ONLY IN ACCORDANCE WFFH ALL MY OF ATLANTIC BEACH ORDINANCES AND rOF FLORIDA
BUILDING CODES.
PLUMBING PERmrr APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904)247-5826 Fax (904)247-5845
JOBADDRESS: -300 '5-"' :S4-r�E-_�+ --,22-25 -3 PERMIT# L,5-KAA?_-qJ
NEW OR REPLACEMENT INSTALLATION: Project Value s__L_q 0 0. -;:�
TYPEot,FbauRE QTY TYPE oF FbavRE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Fluor Drain Three Comparunent Sink
Floor Sink Toilet
How Bibs Urinal
Kitchen Sink Vacuum Bmakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
RE-PIPE:
7)rrEoFFLYruRE QTY TYPE oF FLYruRE QTY
Bathtub Septic Tank&Pit
Clothes Washer Sbower
Dishwasher Shower Pan
Drinking Fountain Slop Si
Fluor Drain Three Comparmlent Sink
Floor Sink Toilet
How Bibs Urinal
Kitchen Sink Vacumm Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
El Sewer Replacement 0 Back Flow Preventer Ei Grease Interceptor(Trap) gallons(Requim 3 sets of plans)
El Lawn Sprinkler System-Nuumber of Heads El Well
** &)RWD Well Completion Form. Completed formtobe submitted to the Building Department for final inspection.**
Ei Other
Ptarnitb.soid if weakdoesnoten.withirt.six month periodorwark is suspended or abandoned toy six ramths.1 herebyeertify unit I have read
this application and know the sarne he be Ime and morect. All provisions of laws and ordinances governing this work wfll be complied with whether speefflod
or mt. The peranit does mt give authority to violate the provisions of any other state or local law regulation coremetion,or the perforomme of warstroction.
Property Owners Name Phone Number
Plumbing Company V4�,rrxL A 7EC,�_Qffice Phone -L�a�6 Fax3a5-q3_*X5
Co. Address: 51 (S L�, City State F k,Zip 7!;-M
License Holder(Print): R State Certification/Registration#Sf2c�l Skin,
NotarizedSignatureqfLicemeHold�ff � V�;�
Sworn and �Hkribed before me this—day of 20
Signature of Notary Public