290 BEACH AVE - PLUMBING CITY OF ATLANTIC BEACH
800 SEMINOLE ROAD
J ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5826
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
JOB INFORMATION:
Job ID: 15-PLBG-2495
Job Type: PLUMBING ONLY
Description: 33 FIXTURES
Estimated Value:
Issue Date: 10/20/2015
Expiration Date: 4/17/2016
PROPERTY ADDRESS:
Address: 290 BEACH AVE
RE Number: 170196-0010
PROPERTY OWNER:
Name: PITLER, ANDY
Address: 273 OCEAN BLVD
GENERAL CONTRACTOR INFORMATION:
Name: COGBURN AND WAKEFIELD PLBG
Address: 5900 TOWNSEND BLVD APT 522 QA JOHN COGBURN
Phone: - -
FEES:
Trade Permit Base Fee $55.00
Plumbing Fixtures $231.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Total Payments: $290.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITII 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: )■90 i3cAct Aimee PERMIT# $ SFe-I
NEW OR REPLACEMENT INSTALLATION: Project Value$
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 s • Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray — Water Connected Appliances '}
Lavatory /6 Water Heater aZ.
Other Fixtures / Water Treating System
RE-PIPE:
TYPE OF FIXTURE QTY /5 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 3 o S CZ) 3 K 11 d i`■ , Co,-'tra s Phone Number /oil- ay/.ono
Plumbing Company bu pu 4- ("-)A Le-ec_be flu/'iii fluAiii Office Phone WY- s27-t2c0 Fax Air '371-0O3)
Co. Address: 410/ TA a .. S City Z4-.K State Ft Zip 3 Z210
License Holder(Print): 1.,‘n - - tate Certification/Registration# GAL I�(28i►�[a
. 7. /
Notarized Signature of License Holder x 1
$� p4 Notary Public State of FI•".- o me '' • ' ' � V ` / 2n
Shirley L Graham
tc. My Commission FF 0888ign.. re of Notary Public I
or w Expires 02/14/2018 - •