178 BEACH AVE - PLUMBING 6� ' _ . CITY OF ATLANTIC BEACH
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J 800 SEMINOLE ROAD
�!w - . ATLANTIC BEACH,FL 32233
<� INSPECTION PHONE LINE 247-5814
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PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
30B INFORMATION:
Job ID: 15-PLBG-1821
Job Type: PLUMBING ONLY
Description: MINOR PLUM REPARIES
Estimated Value:
Issue Date: 7/29/2015
Expiration Date: 1/25/2016
PROPERTY ADDRESS
Address: 178 BEACH AVE
RE Number: 170210-0000
PROPERTY OWNER:
Name: 178 BEACH AVE LLC
Address: 6 E BAY ST SUITE 500
GENERAL CONTRACTOR INFORMATION:
Name: F.W. FAIR PLUMBING CO.
Address: P 0 DRAWER 51558 QA FRED FAIR
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $0.00
Trade Permit Base Fee $55.00
Total Payments: $59.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (9004))247-5826 Fax(904) 247-5845
JOB ADDRESS: 17 y v �l"V14 A J tr PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$ I 1/0 C).'
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:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
❑ Lawn Sprinkler System-Number of Heads ❑ Well **
**SJRWD Well Compler Form. Completed form to be submitted to the Building Department for final inspection.**
❑ Other Iy L�� J pl S ik'('-Pa l n
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 }} y ' Imo( Phone Number `�/
Plumbing Compan F�J • �" (t P6 v Mie/ ' "Office Pho —)( Q( Fat "
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Co. Address: • G D� ��U J • Cit J Q Stater Zip 3� T
License Holder(Print): `'� r . • • - •• ication/Registration 0 b 7 CPI
Notarized Signature of License Holder 11, _\
oa r°��, Notary Public State of Florida : •,ore me this �� y `'� . 20
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Shirley L Graham
My Commission FF 086990 Si iature of Notary Publicit∎ �1
?off Ftoa Expires 02/14/2018 - •