303 10TH ST - PLUMBING - 25 FIXTURES '�'`�`" \S CITY OF ATLANTIC BEACH
'' 1) 800 SEMINOLE ROAD
____j
_i 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 -2951
Job Type: PLUMBING ONLY
Description: Plumbing - 25 fixtures
Estimated Value:
Issue Date: 12/29/2015
Expiration Date: 6/26/2016
PROPERTY ADDRESS:
Address: 303 10TH ST
RE Number: 170063 - 0000
PROPERTY OWNER:
Name: BOUY, KIM L
Address: 303 10TH ST
GENERAL CONTRACTOR INFORMATION:
Name: B & G PLUMBING CO., INC.
Address: 2232 CORPORATE SQUARE BLVD QA GENE CHRISTIAN
ROVER
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
State PLMG DCA Surcharge $2.00
Plumbing Fixtures $175.00
Trade Permit Base Fee $55.00
Total Payments: $234.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
12- 29- 15;06:31 ;From:B and G Plumbing To:2475845 ;9042233750 # 1/ 1
PLUi'n ING PEI1VrIi APPLICATION
CITY OF ATLANTIC BEACH 15 ... Q 1,,.,SG• ft. Vi5 S
800 Seminole Rd Atlantic Beach, FL 32233
Ph (904) 247 -5826 Fax (904) 247 - 5845
rOB ADDRESS: 2 () 3 1 0 I'' S-C1.
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FIXTURE QTX TYPE OF FIXTURE OTY
Bathtub 0— Septic. Tank & Pit
Clothes Washer i Show9 3 •
Dishwasher 1 Show :r Pan
Drinking Fountain 1 Slop Sink
Floor Drain r Three Compartment Sink
Floor Sink Toilet. _.
Hose Bibs 5 Urinal �-
Kitchen Si tk i - Vacuum Breakers -
Laundry Tray r Water Connected Appliances l
Lavatory two '' Water Heater i
Other Fixtures ) Water Treating System, _1-
RE- PIPE:
TYPE OF Fi. TU.RE PTY IFP.E OF FDCTURE OTY
Bathtub Septic, Tank & Pit
Clothes Washer Shoe er
Dishwasher Show er Pan
Drinking Fountain Slop Sink
Floor Drain Threes Compartment Sink
Moor Sink - Toilet
Hose Bibs Tirim1
Kitchen Sink Vacuum Breakers
Laundry Tray Water Connected Appliances
Lavatory Water Heater
Other Fixtures - Water Treating System
iViISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
O Lawn Sprinkler System - Number of Heads o Well **
'''' SJRWD Well Completion Farm. Completed form to be submitted to the Building Department for final inspection.'""
❑ Other
Permit becomes void if work does not comhzrertce within a six month period or work is suspended or abandoned for six months. I hereby certify that 1 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 docs not give authority to violate the provisions of any other state or local Iaw regulation. construction or the performance of construction.
Property Owners Name 16 1►1 L . e 6v/ Phone Number
Plumbing Company ' ( ��� L C, _ Office Phone 3A 3 ' [ Fax VO --3 7 / •
Co. Address: . . .,r r \ l'1„,4 City State $: - k. Zip 32zA.,
License Holder xamt : �s�'.ac- �.. �� c� d.
(P ) m State Certification/Registration # 03.4"4
Notarized Signature of License Holder ,1�1 C I
LOR1 S, NORDGREN thus A `I 714 day of 0w~CFfii iitr2 20 it.
p�Y Swox and subscribed before
= �� Notary Public - State o Florida
`• ; i�� ; My Comm. Expires Mar 10, 2016 ,. • / ' '
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. ti �,. Commission # EE 17 0657 y 1. f .c•►
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