593 TIMBER BRIDGE LN - PLUMBING Ii 1c,
^�s f CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
j J1',1Jr.
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-PLBG-1584
Job Type: PLUMBING ONLY
Description: 18 FIXTURES NEW SERVICE
Estimated Value:
Issue Date: 7/1/2015
Expiration Date: 12/28/2015
PROPERTY ADDRESS:
Address: 593 TIMBER BRIDGE LN
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: C.W. WOOD PLUMBING
Address: 1328 ROMNEY ST QA WALLACE SCOTT WOOD
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $126.00
Trade Permit Base Fee $55.00
Total Payments: $185.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax (904) 247-5845
JOB ADDRESS: —5- .3 Pi L c 13/ ij P GI? PERMIT #
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub _i___ Septic Tank&Pit
Clothes Washer / Shower
Dishwasher / Shower Pan __
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet _
Hose Bibs 3 Urinal
Kitchen Sink /- Vacuum Breakers
Laundry Tray _L— Water Connected Appliances
Lavatory _ Water Heater —/ _
Other Fixtures Water Treating System
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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
'1, Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
MISCELLANEOUS:
❑ 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 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 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 d%C ai,44aid ‘2,'"Qa�y Phone Number
Plumbing Company C_ G✓- Ake" ,/ )-b)-1 / Office Phone 7W-- VFax
Co. Address: /3 zr Afr// r sT . City .�a- StateX Zip 3 zl//
License Holder(Print): (./ .3"a5)--/ 611 '0' State Certification/Registration#K-l"C OS 7O?7
Notarized Signature of License Holder 6/1./, -16 G" 62.)c-v-zi
000 P4eL Notary Public State of Florida Before me this day •f 111110
;
P
Shirley L Graham .�
a My Commission FF 086990
+ ;F�,d Expires o2na�zo�s Signature of Notary Public i41 Ilk