1857 BEACH AVE PLUMBING CITY OF ATLANTIC BEACH
'61 800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
30B INFORMATION:
Job ID: 15-PLBG-1268
Job Type: PLUMBING ONLY
Description: 1 FIXTURE
Estimated Value:
Issue Date: 6/2/2015
Expiration Date: 11/29/2015
PROPERTY ADDRESS:
Address: 1857 BEACH AVE
RE Number: 169723-1120
PROPERTY OWNER:
Name: SCHLEICHER, ROY
Address: 1857 BEACH AVE
GENERAL CONTRACTOR INFORMATION:
Name: POLAR PLUMBING
Address: P O BOX 2004 MICHAEL RICHARD NIOETTE
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $7.00
Trade Permit Base Fee $55.00
Total Payments: $66.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLI ATION
CITY OF ATLANTIC RE,kCH
800 Semimle Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5945
JOB ADDRESS: n PEItM1T
NEW OR REPLACEMENT INSTALLATION: Project Valu
TYPEOFFLWWRE QYY TYPEorFxwRK QTY
Bathtub Septic Tank&Ph
Clothes Wasber Shower
Dishwasher __ Shower Pa
Drinking Fountain Stop Sink
Floor Drain Twee Com cut Sink
Floor Sink Toilet
Hose Bibs Urinal
Kitchen Sink Vacuum B rs
l.wndry Tray water
Con ted Appliances
Weer Rea r
Otheraoses _ Water Treir ng System _.
RF,PIPE: n...
TYPEOFFIXrVRE QTY TYPE OF Ory
Bathtub Septic Tani &Pit
Clothes Washer Shower —'
Dishwasher Shower Pat ..�
Drinking Fountain Slop Sink
Floor Drain Three Com arintem Sink _
Floor Sink Toilet
Hose Ribs Urinal
Kitchen Sink �_ Vacuum B ars
LaundryTrey wWater
ow Con acted Appliances
La akory Warr
Other Fixtures Water Tres ing Sync
MISCELLANEOUS:
Sewee Replacenkent O Beek Flow Prtwenter a Grease luterc Ptor( rap)_ga110ns(Re9a@sa 3 nen of Plans)
❑ Lawn Sprinkler System-Number offleads C Well
s'VRWD Well Completion Form.Comply be submitted to Bding Department fer final inspection
❑Other
pinna taromn eow ifwwk doe nae mMce within asu month patiod or wink it r Pw k win b.¢[hedry eerily tha t hs & W
air applinsamsW haw MswcmfK ouc end cortin. All provfslonsof tswsavd mdi�unear aninBeis workwNlbecomDlied with wMNer epuifrca
Drom. TM Pn'nk non not Give aunorvy aviolete the Pmvlsioas ofeny Questar or lowtlaw lsrimonewuaim ache p��4onnen«ofconstmaion.
Property Owners Now Phone Number
Plumbing Company � M Off 7'Il�^fr Phimc 'a Fa�{"0'�1�•� )
Co,Address:QS P,,wY� city state },F yip-3r6,La
License Holder(Print): Stine • tcntion/Registrsaion#(R) ,4nAq�
Notarized Signature of License Holds
;r
SW
and su d bef me day 20
l9, BARAR F=AN
ii•I
woo srFowsta Sigoahue of Notary Pu
jezfv asneum.oa.znte
(aan ieaato PlmAaaasrramKm.cam