165 Ocean Gate Dr - Plumbing 10 Fixtures S \ CITY OF ATLANTIC BEACH
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: 16 -PLBG -345
Job Type: PLUMBING ONLY
Description: 10 FIXTURES
Estimated Value:
Issue Date: 2/12/2016
Expiration Date: 8/10/2016
PROPERTY ADDRESS:
Address: 165 OCEAN GATE DR
RE Number: None
GENERAL CONTRACTOR INFORMATION:
Name: ADVANTAGE PLUMBING
Address: 880 MAYPORT RD QA GREG GAUSE
Phone: - -
FEES:
Trade Permit Base Fee $55.00
State PLMG DCA Surcharge $2.00
State PLMG DBPR Surcharge $2.00
Plumbing Fixtures $70.00
Total Payments: $129.00
PERMIT IS APPROVED ONLY IN ACCORDANCE WITH ALL CITY OF ATLANTIC BEACH ORDINANCES AND THE FLORIDA
BUILDING CODES.
PLUMBING PERMIT APPLICATION 3 ,[
CITY OF ATLANTIC BEACH b(® ' 800 Seminole Rd Atlantic Beach, FL 32233 1-(41
�� Ph (904) 247 -5826 Fax (904) 247 -5845 /$ 5/ [
JOB ADDRESS: 5t S (1 (64N /7 / E' 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 .,7 Water Heater
Other Fixtures Water Treating System /
RE -PIPE: `
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 **
** 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 136gC s t /9i) /d9/ Phone Number
Plumbing Company ( dt/41'IT L'_ Ain-111/ra j Office Phone 2/7W Fax 2L'7 - Q ' /
Co. Address: W 0 / 1 2 / p )rf /2 J City e a (J1 State ri._ Zip 3Z2
License Holder (Print): : ' 4 /, .4 . State Certificatio ' ation # CFC. /<IZ 95q
—.4.45
Notarized Signature of License Holder � '
i , , Nota Publie State of Florida Sworn ands cribed before me this / / day of fi .8 < 20 1
% i
4 . Kurt Sandberg .' ; o9 iois 164674 Signature of Notary Public �� )-/'1 l �r � n