319 19TH ST - PLUMBING fr
SI, CITY OF ATLANTIC BEACH
r 4 .j 800 SEMINOLE ROAD
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-2878
Job Type: PLUMBING ONLY
Description: 4 PLUMB FIXTURES
Estimated Value:
Issue Date: 12/14/2015
Expiration Date: 6/11/2016
PROPERTY ADDRESS:
Address: 319 19TH ST
RE Number: 172020-0920
PROPERTY OWNER:
Name: SIROIS, STEPHEN
Address: 319 19TH ST
GENERAL CONTRACTOR INFORMATION:
Name: STEEG PLUMBING
Address: 1601 MAIN ST QA JAMES STEEG
Phone: - -
FEES:
Trade Permit Base Fee $55.00
Plumbing Fixtures $28.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Total Payments: $87.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
1 BUILDING CODES.
PLUMING PERMIT APPLICATION
Cray OF ATLANTIC BEACH .
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904) 247-5826 Fax(904) 247-5845
JOB ADDRESS: v11 • - , . 1le ,'A PEST
u
IN W OR REFLACEME T INSTALLATION: Project Value$
TYPE OF FaroRE Qri TYPE OFF TJRE Orf
Bathtub Septic Tank&Pit
Clothes Washer Shower
Dishwasher Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Cemoartrneu�j
Sink
Floor Sink Toilet
• Hose Bibs • .. IUr'iaal•
Kitchen Sink — Vacuum.Breakers
Laundry Tray Water Connected Appliances
Lavatory _ Water Heater
Other Fixtures Water Treating System
RE-PIPE:
•
T TE OF FIXTURE OZ y TYPE OFFar-EIRE . Orr
Bathtub / Septic Tank&Ph
Clothes Washer _I__ • - Shower
Dishwasher . Shower Pan. • =s-
Drinking Fountain Slop Sink
Floor Drain Three Compar ent Sink
Floor Sink Toilet
Hose Bibs 2 Urinal
Kitchen Sink / Vacuum. Breakers
Laundry Tray Water Connected Appliances /
Lavatory _ _ Water Heater •
Other Fixtures Water Treating System
MISCELLANEOUS: . dns(Requires 3 sets of Ow
Sewer Replacement 0 Back Flow Preventer 0 Crease Interceptor(Trap) � (R
Lawn Sprinkler System-Number of Heads 0 Well ** •
SJRWi) Well Completion Form. Completed form to be submitted to the Building Depar`nlent for f al inspection.
•
u Other
___ fry that I Save
Per„it becomes void if work does not commence wiwithin a six month period or work is suspended or abandoned for she months.t hereby eel-01Y eci5
tilts appiication and know the saAle to be true and correct All provisions of laws and ordinances governing this work will be complied ovin whether
or not. The permit does not give authority to violate the provisions of any other she or local law regulation construct on or the performance
/ Phone Nu her
ProuertY Owners Name %1.. Z.L.A∎ J . I•
fr
Office ce Phone Fax Company �o /
-L d State-Zip-32_23,Address: i� _•� City
License Holder(Print): � 5/C ---
�r_a-7��
i in ' #
vot`ariZed Si -nature of License Holder �.•.� J'
,c� day of 20-
Swo�and s, ,r c�xbed before me this
• . Signature of Notary Public •