157 BELVEDERE ST - PLUMBING `� CITY OF ATLANTIC BEACH
;. S 800 SEMINOLE ROAD
-, ATLANTIC BEACH,FL 32233
INSPECTION PHONE LINE 247-581:4
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION: o
Job ID: 15-PLBG-2173
Job Type: PLUMBING ONLY .
Description: PLUMBING - 3 FIXTURES
Estimated Value:
Issue Date: 9/14/2015
Expiration Date: 3/12/2016
PROPERTY ADDRESS:
Address: 157 BELVEDERE ST
RE Number: 170584-0000
PROPERTY OWNER:
Name: BURCH, ROBERT & LESLEE ANN, *
Address: 157 BELVEDERE ST
GENERAL CONTRACTOR INFORMATION:
Name: FOSTER PLUMBING. INC.
Address: 2905 HODGES BLVD QA STEPHEN HAROLD FOSTER
P hone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $21.00
Trade Permit Base Fee $55.00
Total Payments: $80.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE,
BUILDING CODES.
I
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233 i c-- .PL eD 6-Z t
Ph(904)247-5826 Fax(904)247-5845
JOB ADDRESS: i S 7 + L_.-v.i3L9�-- ��, PERMIT# 1-S-- I 1 g'
NEW OR REPLACEMENT INSTALLATION: Project Value$
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher j 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 m L Water Treating System
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RE-PIPE:
TYPE OF FIXTURE QT f' 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 1&:ke .41E. g Or.4.14 Phone Number
Plumbing Company -f STS eLS)ro.re/■U G C_D, Office Phone 8a ` 07 07 Fax S'v/ E-
Co. Address: z9 OS /nom cSZ VV City . -AA.)( State F1— Zip -42
License Holder (Print): STS' , fcS'7: St.te Certification/Registration# CfCO.S 13 o
Notarized Signature of License Holder '�I x
Before me this day of 20
Signature of Notary Public