255 PINE ST - PLUMBING PERMIT rat Kf./.'.•
°' °S, CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J ' 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
JOB INFORMATION:
Job ID: 15-PLBG-2107
Job Type: PLUMBING ONLY
Description: NEW PLBG SERVICE 18 FIXTURES
Estimated Value:
Issue Date: 9/4/2015
Expiration Date: 3/2/2016
PROPERTY ADDRESS:
Address: 255 PINE ST
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: SUNSHINE STATE PLUMBING
Address: 1340 TRAILWOOD DR MICHAEL TROY PORTER
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: $185.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
09/04/2015 09:54 (FAX) P.0011001
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247-5826 Fax (904) 247-5845
JOB ADDRESS: 255 PINE STREET,ATLANTIC BEACH PERMIT# ( S' Sr-g- rr•3S
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 2 Septic Tank&Pit
Clothes Washer 1 Shower
Dishwasher 1 Shower Pan 1
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet 3
Dose Bibs 2 Urinal
Kitchen Sink 2 Vacuum Breakers
Laundry Tray Water Connected Appliances 1
Lavatory 4 Water Heater 1
Other Fixtures Water Treating System
RE-PIPE: \1 i
TYPE OF FIXTURE QTY TYPE OF FIXTURE QT
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 J 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 Biggar Phone Number (40/7 f 6,25--3158
Plumbing Company Sunshine State Plumbing Office Phone 904-262-106616 Fax 904-262-0358
Co. Address: , 710 Haines Street City Jacksonville State FL Zip 32202
License Holder(Print): Michael T. Porter State Certification/Registration # CFC 1426859
Notarized Signature of License Holder 4/(Z n _
*n''''"ft,, DAVINA R.DICKERSON Sworn and subscribed before me this • day of 5p4t1 20 C�
o MY OMISSION 9 FF CS1309
* ,..%,;I '.i�* EXPIRES:Octa� 22Service e Signature of Notary Public 5
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