510 ORCHID ST - PLUMBING , A • Art CITY OF ATLANTIC BEACH
J 800 SEMINOLE ROAD
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-1443
Job Type: PLUMBING ONLY
Description: ABANDON SEPTIC TANK
Estimated Value:
Issue Date: 6/19/2015
Expiration Date: 12/16/2015
PROPERTY ADDRESS:
Address: 510 ORCHID ST
RE Number: 170905-0510
PROPERTY OWNER:
Name: MEWBORN, PATRICIA
Address: 510 ORCHID ST
GENERAL CONTRACTOR INFORMATION:
Name: ADVANTAGE PLUMBING
Address: P 0 BOX 49225
Phone: 904-247-9848
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: $66.00
PERMIT IS AI'PROVED ONLY IN ACCORDANCE W i I'll ALL (Try OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
d ..,_`0� CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904)247-5845
PI — I N(43
JOB ADDRESS: 3/D O R( , S T PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE 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
RE-PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE 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:
l 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 B�uil 'ding Department for final inspection.**
❑ Other ilg fid0l4C fp ( %i) i k
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 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/1-1 R I L i 1 Piet()eu) oO i2../ Phone Number
Plumbing Company Odvnni qe_ Pl A'lf)irl Office Phone MT-1'M Fax 2'7-Q 9/
Co.Address: �
WO ��J/""p f City State TL Zip 3 33
License Holder(Print): _ /'./ /, , _ State Certificatio r/: - ., ii : ion#CFG/4,2A 9 q
Notarized Signature of License Holder _Alai e_
it r�mry Pubac stab a Sworn ands► • 'bed before me this day of 20
Kim Sandberg
a M 18164674 Signature of Notary ■Public�►'. A� ! .I A%/i
�i