138 SANDY BEACH LN. - PLUMBING 10 FIXTURES 1P.--
j j J� '� CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
__, - .,:4551.4/-)
ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-5814
J,31>f'
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-PLBG-1782
Job Type: PLUMBING ONLY
Description: 10 FIXTURES
Estimated Value:
Issue Date: 7/24/2015
Expiration Date: 1/20/2016
PROPERTY ADDRESS:
Address: 138 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 $55.00
Total Payments: $129.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax(904)247-5845
JOB ADDRESS: C' - i3?UC.LL Jet PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QT v
Bathtub _l___ Septic Tank&Pit
Clothes Washer / Shower J
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs —t___ Urinal
Kitchen Sink I 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:
❑ 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 V4,0ar /7 f Phone Number
Plumbing Company ad✓&Y)? PuiriAihg Office Phone,'Z 7-(iW r1 Q W Fax zL/ i 1"
Co. Address: ggg /a p)t-7�!U4 City/f/ 669 ell State J 2_ Zip 3223
License Holder(Print): _ ,e /, : ' _ State Certificatio lion#CFC/NZ 959
Notarized Signature of License Holder .1.41r„
Notary PuW4c Stets of Florida Sworn and s . cribed before me this ezi7�day of - i/y 201.3
Kim Sandberg y
.1/4.risfr, Exphas 09/300 8 164674 Signature of Notary Public lii'Y1;_ G71'14- p