701 BEACH AVE PLUMBING �1 Ijflc>
CITY OF ATLANTIC BEACH
.S 800 SEMINOLE ROAD
J ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
�r itI
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-PLBG-1350
Job Type: PLUMBING ONLY
Description: 4 fixture
Estimated Value:
Issue Date: 6/9/2015
Expiration Date: 12/6/2015
PROPERTY ADDRESS:
Address: 701 BEACH AVE 101
RE Number: 170237-0702
PROPERTY OWNER:
Name: FORBES, RAYMOND E & BARBARA H, '
Address: 4975 E LAURIE GREEN WAY
GENERAL CONTRACTOR INFORMATION:
Name: STYLES SMITH PLUMBING, INC
Address: 1537 PENMAN RD SUITE A QA DARRELL GLEN SMITH
Phone: -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $28.00
Trade Permit Base Fee $55.00
Total Payments: $87.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph((9904)247--5826 Fax(904)247-58451
JOB ADDRESS: �� / d,���c% /O ( PERMIT
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE oFFixTuRE QTY TYPEoFF/XTuRE 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 I Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
RE-PIPE:
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 Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
D Sewer Replacement D Back Flow Preventer D Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
D Lawn Sprinkler System-Number of Heads D Well
**SIRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
D 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 true 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 m violate the provisions of any other state or local law regulation construction or the performance ofconstruclion.
Property Owners Name /Ya/ /-)s v.�..�r�,✓ Phone Number
Plumbing Company S y/rS S7 .,17--1--Office Phone
Co.Address: 39 Q.� City ekx �4/. State�Zip 3yfo
Print :
License Holder r
(Print): ellr State Certification/Registration# LFwYi B'o�
Notarized Signature ojLicense Holder
Before me this q da of
Signature of Notary Public .14