583 Coastal Oak Ln - Plumbing 19 Fixtures CITY OF ATLANTIC BEACH
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800 SEMINOLE ROAD
9 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: 16- PLBG -10
Job Type: PLUMBING ONLY
Description: PLUMBING - 19 FIXTURES
Estimated Value:
Issue Date: 1/5/2016
Expiration Date: 7/3/2016
PROPERTY ADDRESS:
Address: 583 COASTAL OAK LN
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: CROCKETT PLUMBING COMPANY
Address: 11331 PENDER RAULERSON RD QA WILLIAM JOHN
CROCKETT, JR
Phone: - -
FEES:
State PLMG DBPR Surcharge $2.00
Plumbing Fixtures $133.00
Trade Permit Base Fee $55.00
State PLMG DCA Surcharge $2.00
Total Payments: $192.00
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 I 5 P L , 1 0
JOB ADDRESS: 513 KeAS gym / Do0 i4s L chi. 1 PERMIT #
NEW OR REPLACEMENT INSTALLATION: Project Value $
TYPE OF FIXTURE QTY TYPE OF FIXTURE QTY
Bathtub 2. Septic Tank & Pit
Clothes Washer ___L— Shower _�
Dishwasher ___/___ Shower Pan
Drinking Fountain Slop Sink
Floor Drain Three Compartment Sink
Floor Sink Toilet ,3
Hose Bibs 2. Urinal
Kitchen Sink Vacuum Breakers
Laundry Tray _I_ Water Connected Appliances 1
Lavatory Y Water Heater ___/_
Other Fixtures Water Treating System
RE -PIPE: e\.
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
MISCELLANEOUS:
❑ Sewer Replacement ❑ Back Flow Preventer ❑ Grease Interceptor (Trap) gallons (Requires 3 sets of plans)
❑ Lawn Sprinkler System - Number of Heads ❑ Well * *
** SIRWD 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.
_53, Property Owners Name .r �.
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Plumbing Company 0,1 P/ f /� c' . Office Phorfe 5312 b (o Fax
Co. Address Ccltf?i'J A,. City / «1 State-- Zip3 D4'3
License Holder (Print): Ml o, N9 r/. dock .2Z S . to C- 'ficatio • - gistration ePrO(
Notarized Signature o = , -_ - _ - . - - - _ -./ , , '
ir
TONI GINpL i /
I ; MY COMMSSION e F j d subscribes bef's day of 201 ". \ _ '? _. - EXPIRES Oc tober L i on ----- • - - - c
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