363 4TH ST - PLUMBING J
CITY OF ATLANTIC BEACH
IA
s 800 SEMINOLE ROAD
loy)
j ., 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-1949
Job Type: PLUMBING ONLY
Description: 23 FIXTURES
Estimated Value:
Issue Date: 8/17/2015
Expiration Date: 2/13/2016
PROPERTY ADDRESS:
Address: 363 4TH ST
RE Number: 169843-0100
PROPERTY OWNER:
Name: PHILLIPS, LONNIE
Address: 4648 COLLINSWOOD DR
GENERAL CONTRACTOR INFORMATION:
Name: STEWART PLUMBING CO
Address: 3164 County RD
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $161.00
Trade Permit Base Fee $55.00
Total Payments: $220.00
PERT IIT IS APPROVED ONLY IN ACCORDANCE WIThl ALL CITY OF ATLANTIC REACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax(904) 247-5845
JOB ADDRESS: 36 3 4 A 51-7"..e.e2f-- 3 22-33 PERMIT# /C-Sr- IZ-1142/
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub I Septic Tank&Pit
Clothes Washer Z Shower 3
Dishwasher ____I__ Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet
Hose Bibs 2 Urinal
Kitchen Sink I Vacuum Breakers
0.
Laundry Tray I Water Connected Appliances
Lavatory Water Heater 1
Other Fixtures Water Treating System 1,\-____
RE-PIPE: /
;)
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Z
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:
U Sewer Replacement U Back Flow Preventer U Grease Interceptor(Trap) gallons(Requires 3 sets of plans)
O Lawn Sprinkler System-Number of Heads Well **
**SJRWD Well Completion Form. Completed form to be submitted to the Building Department for final inspection.**
o Other
Permit becomes void if work does not continence 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 pennit 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 ?h /1,DS Phone Number
Plumbing Company S+ewa&-F -Pl Mibrn� ( MiacJihj Office Phone 2o7 ` 3aq Fax
Co. Address: 52L+S' Roher4- scoff- Dr- 5 City TAX Staten- Zip 322°7
License Holder (Print): • ' : . 111.. Ai State Certification/Registration##CFC I'1Z&906
Notarized i nature of License Holder -t"
p^ Notary Public State of Fl +o ' and su�bed befo•- me t' I d:, �, 4/ A__ , 20/O
. Shirley L Graham WC .
�j X' My Commission FF 0869 n; re of Notary Publi-��..A�_/ . -
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