130 SANDY BEACH LN - PLUMBING 10 FIXTURES -jrV1. ,.
f- JJ;
TSB CITY OF ATLANTIC BEACH
,1 f 800 SEMINOLE ROAD
of ;" ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
�J,,1>r
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
30B INFORMATION:
Job ID: 15-PLBG-1781
Job Type: PLUMBING ONLY
Description: 10 FIXTURES
Estimated Value:
Issue Date: 7/24/2015
___ Expiration Date: 1/20/2016
PROPERTY ADDRESS:
Address: 130 SANDY BEACH LN
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 S55.00
Total Payments: $129.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach,FL 32233
Ph(904)247-5826 Fax(904) 247-5845
Jos ADDRESS: / Cl
,D _ LCL( Bea.a. .kckluz._.,
PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub _L____ Septic Tank&Pit
Clothes Washer 1 Shower /
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 2
Hose Bibs __L___ Urinal
Kitchen Sink I Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory 2. 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:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well **
** SIRWD 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 .,beezies FIQ.Ea Phone Number
Plumbing Company az/ya dage Puir)oing Office Phone Z 7-ci W Fax,�'7-Q /
Co. Address: WO /ai fpOr+/2d ✓J City F)+/_6. State IL Zip 3Z2-3-i
License Holder(Print): '/ 1 . . _ State Certificatio : . kill ation#CFC/N,Z�95q
Notarized Signature of License Holder _J �_-
Notary Public State of Florida Sworn and s . cribed before me this 2f day of _ 7 l r 20 /5
Kim Sandberg
¼,c/ Expires 09/30/2018 164874 Signature of Notary Public li-r11,_G7i 649