133 OCEANGATE - PLUMBING PLUMBING PERIVIIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845 #
PERiviT I L5
r _II r i
SOB ADDRESS:
PLACEMENT INSTALLATION:
Project Value$
NEW OR RE QTY
QTY TYPE OF FIXTURE
TYPE OF FIXTURE ' ✓ Septic Tank&Pit
Bathtub Shower --
Clothes Washer Shower Pan
Dishwasher Slop Sink ent Sink T--
Drinking Fountain Three Compaq
Floor Drain — Toilet
Floor Sink Urinal
Hose Bibs
Kitchen Sink ---- Water Connected Appliances —�-- (1?)Laundry Tray Water Heater
Lavatory Water Treating System
Other Fixtures -----
RE-PIPE: QTR
QTY TYPE OF FIXTURE
TYPE OF FIXTURE Septic Tank&Pit -------
Bathtub — Shower --
Clothes Washer -- Shower Pan ---–
Dishwasher
Drinking Fountain Slop Sink ---
Three Compartment Sink ._._-.--
Floor Drain ------ Toilet
Floor Sink Urinal ----
Hose KitcBibs Vacuum Breakers Appliances itchen Sink Water Connected App
Laundry Tray Water Heater
Lavatory Water Treating System —
Other Fixtures
MISCELLANEOUS: allons(Requires 3 sets of plans)
❑ Sewer Replacement ❑ Back Flow Preventer o Grease Interceptor (Trap) ** g
❑ Lawn Sprinkler System Number of Heads
0 Well
** S .RWD 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 reac
this application and know the same 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 to violate the provisions of any other state or local law regulation construction or the performance of construction.
Property Owners Name P EA i k P$ 0 i)19 ti r Phone Number �,�
Plumbing Company I i /1i f_ f '. ✓ �I A / . Office Phone,`Z.'7/ -�f W Fax 2L/7- Q ' /
Co. Address: WO may pc)rf Rd City pfi ev oil State/ Zip,32
License Holder(Print):
/,4r / • State Certificatio 1 : -t ii ation#CFC/.42�95Q
Notarized Signature of License Holder ��� - .2 �_--_
r . Notary PuWlc stagy a FSonda Sworn and s' . cribed before me this I day of ,)O ft F- 20 1-c
4r Kim Sandberg n
.4,0.0.0./ ei �061304078 164674 Signature of Notary Public L.,YYI� �'j�C/�.Q
�S v \� CITY OF ATLANTIC BEACH
) 800 SEMINOLE ROAD
\J ATLANTIC BEACH, FL 32233
\. INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-PLBG-1453
Job Type: PLUMBING ONLY
Description: INSTALL 10 FIXTURES
Estimated Value:
Issue Date: 6/19/2015
Expiration Date: 12/16/2015
PROPERTY ADDRESS:
Address: 133 OCEAN GATE DR
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: ADVANTAGE PLUMBING
Address: 880 MAYPORT RD QA GREG GAUSE
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $70.00
Trade Permit Base Fee $55.00
Total Payments: $129.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.