1897 BEACH AVE - PLUMBING � CITY OF ATLANTIC BEACH
. .,, 800 SEMINOLE ROAD
J
10/ ATLANTIC BEACH, FL 32233
INSPECTION PHONE LINE 247-5814
PLUMBING PERMIT
MUST CALL BY 4PM FOR NEXT DAY INSPECTION: 247-5814
)OB INFORMATION:
Job ID: 15-PLBG-2915
Job Type: PLUMBING ONLY
Description: 29 fixtures
Estimated Value:
Issue Date: 12/17/2015
Expiration Date: 6/14/2016
PROPERTY ADDRESS:
Address: 1897 BEACH AVE
RE Number: 169687-0000
PROPERTY OWNER:
Name: STEELE TRUST. ALLEN J
Address: 7174 RAMOTH DR
GENERAL CONTRACTOR INFORMATION:
Name: ROLLAND REASH PLUMBING .
Address: 11501 W COLUMBIA PARK DR APT 208 QA ROLLAND R
REASH
Phone: - - — —FEES:
Trade Permit Base Fee $55.00
Plumbing Fixtures $203.00
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Total Payments: $262.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION
CITY OF ATLANTIC BEACH
800 Seminole Rd Atlantic Beach, FL 32233
Ph(904)247-5826 Fax (904)247-5845
JOB ADDRESS: / g9 7�`'J Bec'cL /ems PERMIT#
NEW OR REPLACEMENT INSTALLATION: Project Value$
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 Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures Water Treating System
RE-PIPE:
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub a Septic Tank&Pit V
Clothes Washer / Shower 3
Dishwasher l Shower Pan e
Drinking Fountain ,P1 Slop Sink
Floor Drain pJ Three Compartment Sink �k
Floor Sink I Toilet 5 ;
Hose Bibs 3 Urinal
Kitchen Sink o1. Vacuum Breakers M Laundry Tray I. Water Connected Appliances
Lavatory 7. Water Heater 3
Other Fixtures /f 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 7M Y ol ei I h nn Phone Number I-g
Plumbing Company e0 tAN Y O CAA (UM 6 Office Phone o�6O 51 Faxc I - O47
Co. Address: I1/ ALI*A !/ City A("5e4,1 State fi- Zip
License Holder(Print): _1nLGrtA' / E:14 St. - erti t.,'on/Registration#
Notarized Signature of License Holder _`�i/
1 .00,44. STANLEY C LOGAN Before me this Vi day of - -. : t., \
MY COMMISSION*FF902194 of Notary Public 4
•:;•„ EXPIRES July 22.2019
Signature y
,.o,),.,, .,.1 F�onedlata ySs.vte cow i